Healthcare Provider Details

I. General information

NPI: 1780799270
Provider Name (Legal Business Name): IRA STECKLER GROBAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 16TH STREET NW #115
WASHINGTON DC
20011
US

IV. Provider business mailing address

3900 16TH STREET NW #115
WASHINGTON DC
20011
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-5420
  • Fax: 202-723-9020
Mailing address:
  • Phone: 202-234-5420
  • Fax: 202-723-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number314
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number509
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: