Provider Demographics
NPI:1871754499
Name:CARPENTER, STEPHANIE B (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:B
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BYNUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0838
Mailing Address - Country:US
Mailing Address - Phone:410-535-0892
Mailing Address - Fax:410-535-5677
Practice Address - Street 1:238 MERRIMAC CT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6113
Practice Address - Country:US
Practice Address - Phone:410-535-0892
Practice Address - Fax:410-535-5677
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014288A207R00000X
IN01069672A207R00000X
MDD74973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD599308300Medicaid
INP00982678OtherRR MEDICARE
IN000000725822OtherANTHEM PIN
IN201029140Medicaid
INP00982678OtherRR MEDICARE