Healthcare Provider Details

I. General information

NPI: 1457320962
Provider Name (Legal Business Name): FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 05/26/2011
Certification Date:
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: 301-592-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1309
License Number StateMD

VIII. Authorized Official

Name: DR. STEVEN SELBY BLANKEN
Title or Position: OWNER
Credential: D.P.M.
Phone: 301-592-0505