Provider Demographics
NPI:1093982639
Name:WHELTON, SEAMUS PAUL (MD)
Entity Type:Individual
Prefix:
First Name:SEAMUS
Middle Name:PAUL
Last Name:WHELTON
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:PO BOX 64264
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4264
Mailing Address - Country:US
Mailing Address - Phone:410-955-9434
Mailing Address - Fax:
Practice Address - Street 1:2024 E MONUMENT ST
Practice Address - Street 2:SUITE 2-622
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0007
Practice Address - Country:US
Practice Address - Phone:410-955-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD053141300Medicaid
MD238823Y82Medicare PIN