Provider Demographics
NPI:1164464178
Name:SEALANDER, JOHN YATES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:YATES
Last Name:SEALANDER
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 21975
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4116
Mailing Address - Country:US
Mailing Address - Phone:540-321-4281
Mailing Address - Fax:540-321-4282
Practice Address - Street 1:2503 S SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-2690
Practice Address - Country:US
Practice Address - Phone:540-948-6871
Practice Address - Fax:540-948-6601
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6262DOtherMEDICARE
VA1164464178Medicaid
C86372Medicare UPIN