Active NPI
Stephvon D Keys
- Home Modifications Contractor
- Waldorf, MD
National Provider Identifier
1376187245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 05135836
- Practice address
- 138 Garner Ave
Waldorf, MD 20602-2933 - Phone
- (240) 970-2703
- NPI assigned
- Nov 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 05135836 | MD | Primary |
Addresses
Primary practice location
138 Garner Ave
Waldorf, MD 20602-2933
Mailing address
138 Garner Ave
Waldorf, MD 20602-2933
Phone (240) 970-2703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05135836 | MD | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572825600000",
"number": "1376187245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 GARNER AVE",
"city": "WALDORF",
"state": "MD",
"postal_code": "206022933",
"telephone_number": "240-970-2703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 GARNER AVE",
"city": "WALDORF",
"state": "MD",
"postal_code": "206022933",
"telephone_number": "240-970-2703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEYS",
"first_name": "STEPHVON",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-11-04",
"last_updated": "2019-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "MD",
"license": "05135836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.