Provider Demographics
NPI:1073688750
Name:TAJERSTEIN, SHELDON (DPM)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:TAJERSTEIN
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 1:2835 SMITH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1462
Mailing Address - Country:US
Mailing Address - Phone:410-788-6633
Mailing Address - Fax:410-788-7785
Practice Address - Street 1:2835 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1453
Practice Address - Country:US
Practice Address - Phone:410-580-0900
Practice Address - Fax:410-788-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0642213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD325658802Medicaid
DC446146Medicare PIN
MDT477Medicare PIN
MD325658802Medicaid
0808150001Medicare NSC