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:
Health care specialties
| Specialty | Code | License # | 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 last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902292394 | NPPES |
| Virginia | MEDICAID | 1902292394 | |
| Virginia | MEDICAID | 30017647860001 |
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