Provider Demographics
NPI:1275516312
Name:STEVENSON, BARBARA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8520
Mailing Address - Country:US
Mailing Address - Phone:410-494-1355
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:STE 100A
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1315
Practice Address - Fax:410-584-2244
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR059802207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403571200Medicaid
MDP00065152OtherRR MEDICARE
MDR83626Medicare UPIN
MD403571200Medicaid
215776ZR0ZMedicare PIN