Provider Demographics
NPI:1245319417
Name:DORROW, STANLEY
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:DORROW
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:T
Other - Last Name:DORROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4000 OLD COURT RD STE 302
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6418
Mailing Address - Country:US
Mailing Address - Phone:410-654-0052
Mailing Address - Fax:301-530-3293
Practice Address - Street 1:9010 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1514
Practice Address - Country:US
Practice Address - Phone:301-564-1542
Practice Address - Fax:301-530-3293
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4555122300000X
MD332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6245550001Medicare NSC