Provider Demographics
NPI:1457307761
Name:SEFTEL, MARC A (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:SEFTEL
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 1:550 WATER ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4126
Mailing Address - Country:US
Mailing Address - Phone:831-476-4414
Mailing Address - Fax:831-476-0264
Practice Address - Street 1:550 WATER ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4126
Practice Address - Country:US
Practice Address - Phone:831-476-4414
Practice Address - Fax:831-476-0264
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44368174400000X, 207YP0228X, 207YS0012X, 207YX0901X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No174400000XOther Service ProvidersSpecialist
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443680Medicaid
CAE89172Medicare UPIN
CAMMM00151MMedicare ID - Type Unspecified