Provider Demographics
NPI:1740249309
Name:STOUT, DONALD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 4TH ST NW
Mailing Address - Street 2:UNIT 1005
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4902
Mailing Address - Country:US
Mailing Address - Phone:803-586-1513
Mailing Address - Fax:
Practice Address - Street 1:1101 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5002
Practice Address - Country:US
Practice Address - Phone:202-798-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD041636207R00000X, 207P00000X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102944Medicaid
SC102944Medicaid
SCD09192Medicare UPIN