Provider Demographics
NPI:1720050362
Name:AUSTIN, STEPHEN E (MED, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N CHARLES ST
Mailing Address - Street 2:ATHLETICS, M130
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2601
Mailing Address - Country:US
Mailing Address - Phone:410-617-5276
Mailing Address - Fax:410-617-5709
Practice Address - Street 1:4501 N CHARLES ST
Practice Address - Street 2:ATHLETICS, M130
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2601
Practice Address - Country:US
Practice Address - Phone:410-617-5276
Practice Address - Fax:410-617-5709
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer