Provider Demographics
NPI:1982927935
Name:STEPHEN LAIKEN, MD, PA
Entity Type:Organization
Organization Name:STEPHEN LAIKEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-374-0808
Mailing Address - Street 1:4111 LOWER BECKLEYSVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2248
Mailing Address - Country:US
Mailing Address - Phone:410-374-0808
Mailing Address - Fax:410-374-0045
Practice Address - Street 1:4111 LOWER BECKLEYSVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2248
Practice Address - Country:US
Practice Address - Phone:410-374-0808
Practice Address - Fax:410-374-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786441800Medicaid
MD201RMedicare PIN
MD786441800Medicaid