Provider Demographics
NPI:1215054994
Name:SIDER, SEAN (DPM)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SIDER
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 1:6030 MARSHALEE DR STE 212
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5987
Mailing Address - Country:US
Mailing Address - Phone:410-661-3338
Mailing Address - Fax:410-844-4777
Practice Address - Street 1:7602 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-661-3338
Practice Address - Fax:410-663-6984
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01274213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480002770OtherMEDICARE RAILROAD
MD548128700Medicaid
MD548128700Medicaid
MD6334680001Medicare NSC
MD480002770OtherMEDICARE RAILROAD