Provider Demographics
NPI:1548216708
Name:JOHN WADE SEEDOR MD PC
Entity Type:Organization
Organization Name:JOHN WADE SEEDOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEEDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-521-4677
Mailing Address - Street 1:204 E CHESTER PK.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1709
Mailing Address - Country:US
Mailing Address - Phone:610-521-4677
Mailing Address - Fax:610-521-0951
Practice Address - Street 1:204 E CHESTER PK
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1709
Practice Address - Country:US
Practice Address - Phone:610-521-4677
Practice Address - Fax:610-521-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027831E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA195833OtherBLUE SHIELD
PA0055283000OtherKEYSTONE HEALTH PLAN EAST
PA1031213OtherKEYSTONE MERCY
PAP00294792OtherTRAVELERS MEDICARE
PA55442OtherAETNA
PA195833UPZMedicare ID - Type Unspecified
PA55442OtherAETNA