Provider Demographics
NPI:1710928551
Name:MANN, STEPHAN CHARLES BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:CHARLES BOYD
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:490L PROSPECT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6400
Mailing Address - Country:US
Mailing Address - Phone:240-566-3001
Mailing Address - Fax:240-566-3003
Practice Address - Street 1:490L PROSPECT BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6400
Practice Address - Country:US
Practice Address - Phone:240-566-3001
Practice Address - Fax:240-566-3003
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD271702083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD73925Medicare UPIN