Provider Demographics
NPI:1205007879
Name:STEVEN YELLIN DPM
Entity Type:Organization
Organization Name:STEVEN YELLIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-638-2202
Mailing Address - Street 1:PO BOX 4303
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-4303
Mailing Address - Country:US
Mailing Address - Phone:276-638-2202
Mailing Address - Fax:276-638-8251
Practice Address - Street 1:1001 BROOKDALE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3901
Practice Address - Country:US
Practice Address - Phone:276-638-2202
Practice Address - Fax:276-638-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000370332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5932930001Medicare NSC