Provider Demographics
NPI:1154328284
Name:SEBASTIAN, PETER RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RAYMOND
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:DO
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 1859
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1859
Mailing Address - Country:US
Mailing Address - Phone:410-341-6520
Mailing Address - Fax:410-341-6526
Practice Address - Street 1:32071 BEAVER RUN DR
Practice Address - Street 2:STE B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1773
Practice Address - Country:US
Practice Address - Phone:410-341-6520
Practice Address - Fax:410-341-6526
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00292432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD31831Medicaid
MD31831Medicaid
D76377Medicare UPIN