Provider Demographics
NPI:1982665147
Name:MCKENNA, STEPHEN JAMES (MD, MBA, FACS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAMES
Last Name:MCKENNA
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Gender:M
Credentials:MD, MBA, FACS
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Mailing Address - Street 1:187 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4503
Mailing Address - Country:US
Mailing Address - Phone:240-457-4605
Mailing Address - Fax:240-457-4631
Practice Address - Street 1:187 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 7
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4503
Practice Address - Country:US
Practice Address - Phone:240-457-4605
Practice Address - Fax:240-457-4631
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-03-03
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Provider Licenses
StateLicense IDTaxonomies
MDD0031422208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483881500Medicaid
MD201157Medicare PIN
DC224545Medicare PIN