Provider Demographics
NPI:1871583807
Name:WATERS, STEPHEN F (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:WATERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1288
Mailing Address - Country:US
Mailing Address - Phone:410-641-9450
Mailing Address - Fax:410-641-9515
Practice Address - Street 1:1001 N PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-3735
Practice Address - Country:US
Practice Address - Phone:410-289-6241
Practice Address - Fax:410-289-5533
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-02-02
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Provider Licenses
StateLicense IDTaxonomies
MDD0027993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD363421300Medicaid
MDD73744Medicare UPIN
MD363421300Medicaid