Provider Demographics
NPI:1295796191
Name:DAMM, STEPHEN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:DAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9811 MALLARD DRIVE
Mailing Address - Street 2:STE 202
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3199
Mailing Address - Country:US
Mailing Address - Phone:301-776-2818
Mailing Address - Fax:301-369-3409
Practice Address - Street 1:9811 MALLARD DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3199
Practice Address - Country:US
Practice Address - Phone:301-776-2818
Practice Address - Fax:301-369-3409
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020680207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0222OtherBCBS FEDERAL
26345ROtherBCBS MD
26345ROtherBCBS MD
B92915Medicare UPIN