Provider Demographics
NPI:1306836580
Name:SEASHORE, CARL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOHN
Last Name:SEASHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 MACNIDER
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7225
Mailing Address - Country:US
Mailing Address - Phone:919-966-2504
Mailing Address - Fax:919-966-3852
Practice Address - Street 1:6013 FARRINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8195
Practice Address - Country:US
Practice Address - Phone:984-974-6669
Practice Address - Fax:984-974-9609
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00016208000000X
MA216779208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2004917Medicaid
H87242Medicare UPIN
MA2004917Medicaid