Individual
DR. KENT A STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2435 W BELVEDERE AVE, SUITE 42, BALTIMORE, MD 21215-5224
(410) 601-5547
(410) 601-5835
Mailing address
2401 W BELVEDERE AVE, DEPT. OF CREDENTIALING, BALTIMORE, MD 21215-5216
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D65426
MD
2086S0102X
Surgical Critical Care Physician
D65426
MD
2086S0127X
Trauma Surgery Physician
D65426
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC1923
MEDICARE R/R GROUP #
MD
01
—
P00464112
MEDICARE R/R PROVIDER #
MD
Enumeration date
03/20/2007
Last updated
05/13/2008
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