Provider Demographics
NPI:1154476125
Name:SEAGO, JUDITH J (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:J
Last Name:SEAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:186 MEDICAL PARK LOOP
Mailing Address - Street 2:STE 501
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5222
Mailing Address - Country:US
Mailing Address - Phone:828-586-5594
Mailing Address - Fax:828-586-3040
Practice Address - Street 1:186 MEDICAL PARK LOOP
Practice Address - Street 2:STE 501
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5222
Practice Address - Country:US
Practice Address - Phone:828-586-5594
Practice Address - Fax:828-586-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-02-02
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Provider Licenses
StateLicense IDTaxonomies
NC32570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8975102Medicaid
NCE08615Medicare UPIN
NC8975102Medicaid