Provider Demographics
NPI:1457320962
Name:FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SELBY
Authorized Official - Last Name:BLANKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-592-0505
Mailing Address - Street 1:10313 GEORGIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-592-0505
Mailing Address - Fax:301-592-0503
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-592-0505
Practice Address - Fax:301-592-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1309261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NB5OtherBSDC
293916OtherMAMSI
3441921OtherAETNA
DC20726OtherCHARTERED HEALTH
MD408775500Medicaid
MDA00019Medicare PIN