Basic Information
Provider Information
NPI: 1285613034
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUNTHER
FirstName: STEPHEN
MiddleName: BURKE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 79777
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212790777
CountryCode: US
TelephoneNumber: 4346547794
FaxNumber: 4346545574
Practice Location
Address1: 595 MARTHA JEFFERSON DR STE 180
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229114669
CountryCode: US
TelephoneNumber: 4346545575
FaxNumber: 4346545574
Other Information
ProviderEnumerationDate: 01/11/2006
LastUpdateDate: 10/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X0101250517VAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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