Provider Demographics
NPI:1316590706
Name:MEDSTAR MEDICAL GROUP II, LLC
Entity Type:Organization
Organization Name:MEDSTAR MEDICAL GROUP II, LLC
Other - Org Name:MMG PODIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-558-1403
Mailing Address - Street 1:2000 15TH ST N STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2900
Mailing Address - Country:US
Mailing Address - Phone:703-558-1400
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-2876
Practice Address - Fax:443-444-1487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR MEDICAL GROUP II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty