Provider Demographics
NPI:1164628293
Name:PLOOF, SEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:PLOOF
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 1:3010 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3208
Mailing Address - Country:US
Mailing Address - Phone:336-970-5300
Mailing Address - Fax:336-970-5298
Practice Address - Street 1:3010 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3208
Practice Address - Country:US
Practice Address - Phone:336-970-5300
Practice Address - Fax:336-970-5298
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5624207R00000X
NC2009-016952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2009-01695OtherSTATE - NORTH CAROLINA
NE5624OtherTEMP. EDUCATIONAL PERMIT
NE5624OtherTEMP. EDUCATIONAL PERMIT