Provider Demographics
NPI:1639139504
Name:MOTEW, STEPHEN JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOEL
Last Name:MOTEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:2921 TELESTAR CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1205
Practice Address - Country:US
Practice Address - Phone:703-280-5858
Practice Address - Fax:703-849-0877
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000101208600000X, 2086S0129X
VA01012680712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639133504Medicaid
NC200000101OtherNC LICENSE
NC89129TMMedicaid
NCBM4327121OtherDEA NUMBER
NC200000101OtherNC LICENSE
NCH42412Medicare UPIN
NC89129TMMedicaid