Provider Demographics
NPI:1831183169
Name:PRINCESS ANNE FAMILY PRACTICE
Entity type:Organization
Organization Name:PRINCESS ANNE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:STEGMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-651-0350
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD668MMedicare PIN