Provider Demographics
NPI:1669462271
Name:KOEHLER, STEWART L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:L
Last Name:KOEHLER
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 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-583-0160
Mailing Address - Fax:410-583-0166
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 606
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-583-0160
Practice Address - Fax:410-583-0166
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029233174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113611900Medicaid
MDKT55Medicare ID - Type UnspecifiedINDIVIDUAL #
MD113611900Medicaid