Zelickson, Blake Reid

Zelickson, Blake Reid is an sole proprietor health care provider with primary practice located at 22365 Broderick Drive, Suite 115 , Sterling VA 20166-9362. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Zelickson, Blake Reid can be contacted via phone (170) 399-6400.

Contact Information

Primary practice address
22365 Broderick Drive, Suite 115 Sterling VA 20166-9362
Phone: (170) 399-6400
Fax: (571) 707-8123
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 286353 New York
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 0101269123 Virginia

Profile Details

NPI number 1902292394
LBN Legal business name Zelickson, Blake Reid
Credentials M.D., PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 13th, 2015
Last updated Oct 31st, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902292394 NPPES
Virginia MEDICAID 1902292394
Virginia MEDICAID 30017647860001

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