Provider Demographics
NPI:1962671743
Name:STEPHEN P. CAFFERTY, D.O. & ASSOCIATES,LLC
Entity Type:Organization
Organization Name:STEPHEN P. CAFFERTY, D.O. & ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-737-7885
Mailing Address - Street 1:22333 GREENVIEW PKWY
Mailing Address - Street 2:UNIT 5A
Mailing Address - City:GREAT MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20634-4407
Mailing Address - Country:US
Mailing Address - Phone:301-737-7885
Mailing Address - Fax:301-862-9882
Practice Address - Street 1:22333 GREENVIEW PKWY
Practice Address - Street 2:UNIT 5A
Practice Address - City:GREAT MILLS
Practice Address - State:MD
Practice Address - Zip Code:20634-4407
Practice Address - Country:US
Practice Address - Phone:301-737-7885
Practice Address - Fax:301-862-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0037228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1982692935OtherINDIVIDUAL NPI