Provider Demographics
NPI:1194704023
Name:BLANKEN, STEVEN SELBY (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SELBY
Last Name:BLANKEN
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 1:10313 GEORGIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-592-0505
Mailing Address - Fax:
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-592-0505
Practice Address - Fax:301-592-0503
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO499213E00000X
MD01135213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480013279OtherMEDICARE RAILROAD SERVICES
MD450798300Medicaid
DC88280001OtherBCBS
DC025912100Medicaid
MD162029OtherHIGHMARK MEDICARE
MDKDK7BLOtherBCBS
DC025912100Medicaid
MD450798300Medicaid
MDKDK7BLOtherBCBS