Provider Demographics
NPI:1508809633
Name:YELLIN, STEVEN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:YELLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BROOKDALE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3901
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000370213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009301275Medicaid
VA480034602Medicare PIN
T-90764Medicare UPIN
VA009301275Medicaid