Provider Demographics
NPI:1093715161
Name:DERMAN, SETH G (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:G
Last Name:DERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 PRINCESS RD
Mailing Address - Street 2:STE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2302
Mailing Address - Country:US
Mailing Address - Phone:609-896-0777
Mailing Address - Fax:609-896-3266
Practice Address - Street 1:2 PRINCESS RD
Practice Address - Street 2:STE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2302
Practice Address - Country:US
Practice Address - Phone:609-896-0777
Practice Address - Fax:609-896-3266
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06185200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6898009Medicaid
NJ854754Medicare ID - Type Unspecified
NJ6898009Medicaid