Provider Demographics
NPI:1336130038
Name:SCHOCKET, STANLEY SOL (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SOL
Last Name:SCHOCKET
Suffix:
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 1:21 CROSSROADS DR
Mailing Address - Street 2:SUITE #425
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5441
Mailing Address - Country:US
Mailing Address - Phone:410-581-2020
Mailing Address - Fax:410-654-9264
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE #425
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-581-2020
Practice Address - Fax:410-654-9264
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD15055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD309471500Medicaid
MD217871OtherMD IPA PROVIDER ID#
MDC52-1828318-011OtherCIGNA PROVIDER ID#
MDR7020003OtherBLUE CHOICE PROVIDER ID#
MD97730OtherFLEXCHOICE PROVIDER ID#
MD52-1828318-103OtherPRUDENTIAL PROVIDER ID#
MD500858OtherAETNA INS. PROVIDER ID#
MDC52-1828318-011OtherCIGNA PROVIDER ID#
MD309471500Medicaid