Healthcare Provider Details

I. General information

NPI: 1194704023
Provider Name (Legal Business Name): STEVEN SELBY BLANKEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE SUITE 201
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

10313 GEORGIA AVE SUITE 201
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-592-0505
  • Fax: 301-592-0503
Mailing address:
  • Phone: 301-592-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO499
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: