Provider Demographics
NPI:1598477390
Name:PASSWATERS-STAMPER, MARIAH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:PASSWATERS-STAMPER
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 1:430 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1810
Mailing Address - Country:US
Mailing Address - Phone:410-804-9675
Mailing Address - Fax:
Practice Address - Street 1:901 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5214
Practice Address - Country:US
Practice Address - Phone:215-955-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant