Provider Demographics
NPI:1306822671
Name:SEALES, ALPHA A (MD)
Entity Type:Individual
Prefix:
First Name:ALPHA
Middle Name:A
Last Name:SEALES
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 1:806 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2420
Mailing Address - Country:US
Mailing Address - Phone:859-491-6411
Mailing Address - Fax:859-491-6450
Practice Address - Street 1:806 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2420
Practice Address - Country:US
Practice Address - Phone:859-491-6411
Practice Address - Fax:859-491-6450
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64179385Medicaid
KY00000003380OtherANTHEM
KY50000647OtherPASSPORT
KYK1793801OtherCHOICE CARE
KY1041701Medicare ID - Type UnspecifiedMEDICARE
KYK1793801OtherCHOICE CARE