Provider Demographics
NPI:1346839651
Name:CHOP, STEPHEN MARSHALL
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARSHALL
Last Name:CHOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 CROUSE MILL RD
Mailing Address - Street 2:
Mailing Address - City:KEYMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21757-9109
Mailing Address - Country:US
Mailing Address - Phone:410-775-1745
Mailing Address - Fax:
Practice Address - Street 1:999 CROUSE MILL RD
Practice Address - Street 2:
Practice Address - City:KEYMAR
Practice Address - State:MD
Practice Address - Zip Code:21757-9109
Practice Address - Country:US
Practice Address - Phone:410-775-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD086241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty