Healthcare Provider Details

I. General information

NPI: 1033808563
Provider Name (Legal Business Name): LIEN VAN DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 SPENCERVILLE CT STE 101
BURTONSVILLE MD
20866-1639
US

IV. Provider business mailing address

15300 SPENCERVILLE CT STE 101
BURTONSVILLE MD
20866-1639
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-2629
  • Fax: 301-421-4286
Mailing address:
  • Phone: 301-384-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LIEN VAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 301-384-2629