Provider Demographics
NPI:1013976091
Name:DAVIS, STEPHANIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 BOX HILL CORPORATE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1290
Mailing Address - Country:US
Mailing Address - Phone:800-777-7904
Mailing Address - Fax:
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-8792
Practice Address - Fax:410-328-0716
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14702Medicare UPIN