Healthcare Provider Details

I. General information

NPI: 1699063511
Provider Name (Legal Business Name): JAY SEIDEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 HARFORD RD
BALTIMORE MD
21214-2231
US

IV. Provider business mailing address

5508 HARFORD RD
BALTIMORE MD
21214-2231
US

V. Phone/Fax

Practice location:
  • Phone: 410-426-5508
  • Fax:
Mailing address:
  • Phone: 410-426-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: