1760477756 NPI number — JOHN WADE SEEDOR MD

Table of content: JOHN WADE SEEDOR MD (NPI 1760477756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760477756 NPI number — JOHN WADE SEEDOR MD

Organization/Personal Information

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

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:
1760477756
Entity Type Code:
Individual
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:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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: 55442 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 195833 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-3370210 . This is a "TAX ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0055283000 . This is a "KEYSTONE" 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: 110075785 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C33268 . This is a "NEIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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