Provider Demographics
NPI:1225014459
Name:BART, STEPHAN A SR (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:A
Last Name:BART
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10403 WETHERBURN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163
Mailing Address - Country:US
Mailing Address - Phone:352-586-8547
Mailing Address - Fax:
Practice Address - Street 1:10403 WETHERBURN RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163
Practice Address - Country:US
Practice Address - Phone:352-586-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064938207Q00000X
FLME64842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine