Provider Demographics
NPI:1477243038
Name:STANFORD, DAWN RENEA (PA-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEA
Last Name:STANFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18014 BLISS DR
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2401
Mailing Address - Country:US
Mailing Address - Phone:301-922-3301
Mailing Address - Fax:
Practice Address - Street 1:4416 E WEST HWY STE 410
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4568
Practice Address - Country:US
Practice Address - Phone:202-888-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002232363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical