Individual provider Active NPI

Stephen E Austin, MED, LAT, ATC

  • Athletic Trainer
  • Baltimore, MD
National Provider Identifier
1720050362
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
A0000258 Issued in MD
Practice address
4501 N Charles St
Athletics, M130
Baltimore, MD 21210-2601
Phone
(410) 617-5276
Fax
(410) 617-5709
NPI assigned
Feb 7, 2006
Last updated
Jan 4, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X A0000258 MD Primary

Addresses

Primary practice location

4501 N Charles St
Athletics, M130
Baltimore, MD 21210-2601

Mailing address

4501 N Charles St
Athletics, M130
Baltimore, MD 21210-2601
Phone (410) 617-5276

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
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
A0000258MDMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357257600000",
    "number": "1720050362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 N CHARLES ST",
            "address_2": "ATHLETICS, M130",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212102601",
            "telephone_number": "410-617-5276",
            "fax_number": "410-617-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 N CHARLES ST",
            "address_2": "ATHLETICS, M130",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212102601",
            "telephone_number": "410-617-5276",
            "fax_number": "410-617-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUSTIN",
        "first_name": "STEPHEN",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "MED, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2013-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MD",
            "license": "A0000258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.