Healthcare Provider Details

I. General information

NPI: 1699187096
Provider Name (Legal Business Name): JAY SEIDEL DPM PA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 12/10/2015
Certification Date:
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: 410-426-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number01551
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01551
License Number StateMD

VIII. Authorized Official

Name: DR. JAY SEIDEL
Title or Position: OWNER
Credential: DPM
Phone: 410-905-5496