Provider Demographics
NPI:1528011129
Name:STAIMAN, VICTORIA RUTH (MD)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:RUTH
Last Name:STAIMAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:STE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:410-715-2090
Mailing Address - Fax:410-715-1864
Practice Address - Street 1:7625 MAPLE LAWN BLVD
Practice Address - Street 2:STE 210
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-725-0134
Practice Address - Fax:301-725-0135
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-05-24
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Provider Licenses
StateLicense IDTaxonomies
MDD0054694208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD611901800Medicaid
G94486Medicare UPIN
MD731LO185Medicare PIN