Provider Demographics
NPI:1750467338
Name:BLOCK, MICHAEL KEVIN (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEVIN
Last Name:BLOCK
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 1:3401 BOX HILL CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009
Mailing Address - Country:US
Mailing Address - Phone:410-569-0445
Mailing Address - Fax:410-569-0446
Practice Address - Street 1:3401 BOX HILL CORPORATE CTR DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009
Practice Address - Country:US
Practice Address - Phone:410-569-0445
Practice Address - Fax:410-569-0446
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01244213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAD13OtherBLUE SHIELD
MD1750467338OtherINDIVIDUAL NPI
MD1750467338OtherINDIVIDUAL NPI
MD244350Medicare PIN
MDAD13OtherBLUE SHIELD