Provider Demographics
NPI:1174793913
Name:MARGARET REBA STEVENS ONEILL MD, LLC
Entity type:Organization
Organization Name:MARGARET REBA STEVENS ONEILL MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:REBA STEVENS
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-951-7905
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6931
Mailing Address - Country:US
Mailing Address - Phone:301-951-7905
Mailing Address - Fax:301-951-7011
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6931
Practice Address - Country:US
Practice Address - Phone:301-951-7905
Practice Address - Fax:301-951-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047472207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4035OtherRAILROAD MEDICARE GROUP#
G00739Medicare PIN