Provider Demographics
NPI:1588744882
Name:TEHAN, NARDI & STANTON UROLOGY CENTER CHARTERED
Entity type:Organization
Organization Name:TEHAN, NARDI & STANTON UROLOGY CENTER CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-493-2505
Mailing Address - Street 1:12 FAIRWAY IS
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-9630
Mailing Address - Country:US
Mailing Address - Phone:410-827-9455
Mailing Address - Fax:410-827-7161
Practice Address - Street 1:10215 FERNWOOD RD STE 630
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1184
Practice Address - Country:US
Practice Address - Phone:301-493-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022953174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD177670Medicare PIN