Provider Demographics
NPI:1508856428
Name:SEQUEIRA, THOMAS MARK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARK
Last Name:SEQUEIRA
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 1:6803 MAYFIELD RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-442-7300
Mailing Address - Fax:440-442-9019
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 412
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-442-7300
Practice Address - Fax:440-442-9019
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039830207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439672Medicaid
SE0479645Medicare ID - Type Unspecified
OH0439672Medicaid
OHH153370Medicare PIN