Provider Demographics
NPI:1407883903
Name:KURYLAS, STEPHAN C
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:C
Last Name:KURYLAS
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 1:2191 DEFENSE HIGHWAY
Mailing Address - Street 2:104
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114
Mailing Address - Country:US
Mailing Address - Phone:410-721-2422
Mailing Address - Fax:421-721-2423
Practice Address - Street 1:2191 DEFENSE HIGHWAY
Practice Address - Street 2:104
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114
Practice Address - Country:US
Practice Address - Phone:410-721-2422
Practice Address - Fax:421-721-2423
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4628Medicare ID - Type UnspecifiedMEDCIARE
MDC89000Medicare UPIN