Healthcare Provider Details

I. General information

NPI: 1922477819
Provider Name (Legal Business Name): JAY SEIDEL DPM PA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NORTH POINT RD SUITE 200
BALTIMORE MD
21224-3329
US

IV. Provider business mailing address

1050 NORTH POINT RD SUITE 200
BALTIMORE MD
21224-3329
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-2234
  • Fax: 410-288-3843
Mailing address:
  • Phone: 410-282-2234
  • Fax: 410-288-3843

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 Number
License Number State

VIII. Authorized Official

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