Provider Demographics
NPI:1629248224
Name:STEVEN J TILLES PA
Entity Type:Organization
Organization Name:STEVEN J TILLES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TILLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-944-4000
Mailing Address - Street 1:7131 LIBERTY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4580
Mailing Address - Country:US
Mailing Address - Phone:410-944-4000
Mailing Address - Fax:410-281-1181
Practice Address - Street 1:7131 LIBERTY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4580
Practice Address - Country:US
Practice Address - Phone:410-944-4000
Practice Address - Fax:410-281-1181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN J TILLES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD600928001Medicaid
MD600928001Medicaid
MD0996760001Medicare NSC
MDT1655JMedicare PIN