Provider Demographics
NPI:1861410243
Name:BROWN, STEPHANIE D (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:7141 SECURITY BLVD
Practice Address - Street 2:KAISER PERMANENTE WOODLAWN MEDICAL CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1811
Practice Address - Country:US
Practice Address - Phone:443-663-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400400100Medicaid
MD053MMedicare ID - Type UnspecifiedGROUP
MDG91266Medicare UPIN