Provider Demographics
NPI:1811903792
Name:PROCTOR, STEPHEN I (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:I
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6188 OXON HILL RD STE 603
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3152
Mailing Address - Country:US
Mailing Address - Phone:301-839-6300
Mailing Address - Fax:301-839-3002
Practice Address - Street 1:6188 OXON HILL RD STE 603
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3152
Practice Address - Country:US
Practice Address - Phone:301-839-6300
Practice Address - Fax:301-839-3002
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD38772174400000X, 207V00000X
DCMD21587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE69497Medicare UPIN