Provider Demographics
NPI:1407868045
Name:TILLES, STEVEN JAY
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:TILLES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:JAY
Other - Last Name:TILLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:7131 LIBERTY RD
Mailing Address - Street 2:#100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207
Mailing Address - Country:US
Mailing Address - Phone:410-944-4000
Mailing Address - Fax:410-281-1151
Practice Address - Street 1:7131 LIBERTY RD
Practice Address - Street 2:#100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4579
Practice Address - Country:US
Practice Address - Phone:410-944-4000
Practice Address - Fax:410-281-1151
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T59849Medicare UPIN
MDT165SJMedicare ID - Type Unspecified