Provider Demographics
NPI:1679986970
Name:DE TABLAN, NAOMI RUTH ESTOLAS (DPM)
Entity Type:Individual
Prefix:
First Name:NAOMI RUTH
Middle Name:ESTOLAS
Last Name:DE TABLAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 EASTERN AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2780
Mailing Address - Country:US
Mailing Address - Phone:410-550-0453
Mailing Address - Fax:410-367-3277
Practice Address - Street 1:4940 EASTERN AVE FL 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-0453
Practice Address - Fax:410-367-3277
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1736213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery