Provider Demographics
NPI:1346774627
Name:SEEBERG, JONAS (CPO)
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:
Last Name:SEEBERG
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 BOX HILL CORPORATE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1204
Mailing Address - Country:US
Mailing Address - Phone:410-569-0606
Mailing Address - Fax:
Practice Address - Street 1:3435 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1204
Practice Address - Country:US
Practice Address - Phone:410-569-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH000206222Z00000X
PAPO000144224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD011103100Medicaid
MD4090110001Medicare NSC