Provider Demographics
NPI:1497732762
Name:SEAGO, MARK ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:SEAGO
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 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-380-4072
Mailing Address - Fax:931-490-7043
Practice Address - Street 1:1224 TROTWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-380-4072
Practice Address - Fax:931-490-7043
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN035012207R00000X
TNMD35012208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3861725Medicaid
TN3861726Medicaid
TN4003190OtherBCBS
TN3283015Medicaid
TN3861725Medicaid
3283015Medicare PIN
TNH04005Medicare UPIN