Provider Demographics
NPI:1073693503
Name:CHOICE, SEAN KARL (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:KARL
Last Name:CHOICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 CHERRY VALLEY RD
Mailing Address - Street 2:P O BOX 948
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1323
Mailing Address - Country:US
Mailing Address - Phone:740-522-3774
Mailing Address - Fax:740-522-2221
Practice Address - Street 1:2112 CHERRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1323
Practice Address - Country:US
Practice Address - Phone:740-522-3774
Practice Address - Fax:740-522-2221
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0694502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300096717OtherRAILROAD MEDICARE
OH2050211Medicaid
300096717OtherRAILROAD MEDICARE
OHCH0843283Medicare ID - Type Unspecified