Provider Demographics
NPI:1184616419
Name:STEGMAN, CHARLES DONALD JR (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DONALD
Last Name:STEGMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:30434 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-1400
Mailing Address - Country:US
Mailing Address - Phone:410-651-0350
Mailing Address - Fax:410-651-4857
Practice Address - Street 1:30434 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1400
Practice Address - Country:US
Practice Address - Phone:410-651-0350
Practice Address - Fax:410-651-4857
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0025219207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786991600Medicaid
MD367003OtherMAMSI
MD010000842OtherRAILROAD MEDICARE
74480OtherCOVENTRY OF DELEWARE
MD53032103OtherBLUE SHIELD
H8236OtherFIRST HEALTH
MDT8890001OtherBLUE SHIELD CHOICE
MD786991600Medicaid
MD367003OtherMAMSI