Provider Demographics
NPI:1720567894
Name:PURNELL, STEPHANIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:PURNELL
Suffix:
Gender:
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WYNDHURST AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2495
Mailing Address - Country:US
Mailing Address - Phone:410-800-3280
Mailing Address - Fax:
Practice Address - Street 1:600 WYNDHURST AVE STE 160
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2495
Practice Address - Country:US
Practice Address - Phone:410-800-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0092627207Q00000X
DCMD210002643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA277241Medicaid