1548216708 NPI number — JOHN WADE SEEDOR MD PC

Table of content: (NPI 1548216708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548216708 NPI number — JOHN WADE SEEDOR MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN WADE SEEDOR MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548216708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 E CHESTER PK.
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
RIDLEY PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19078-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-521-4677
Provider Business Mailing Address Fax Number:
610-521-0951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 E CHESTER PK
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
RIDLEY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19078-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-521-4677
Provider Business Practice Location Address Fax Number:
610-521-0951
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEEDOR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-521-4677

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD027831E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 195833 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0055283000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1031213 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00294792 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 55442 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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