Provider Demographics
NPI:1134192834
Name:STANFORD-SCRUGGS, DITRA (DPM)
Entity type:Individual
Prefix:DR
First Name:DITRA
Middle Name:
Last Name:STANFORD-SCRUGGS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WHISPERING CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 WALKER AVE
Practice Address - Street 2:SUITE # 200
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4075
Practice Address - Country:US
Practice Address - Phone:410-653-7744
Practice Address - Fax:410-653-7745
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU38062Medicare UPIN
MD4898640001Medicare NSC