Provider Demographics
NPI:1558343129
Name:SEPULVEDA, SEBASTIAN G (MD)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:G
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 NORTH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2755
Mailing Address - Country:US
Mailing Address - Phone:978-458-2005
Mailing Address - Fax:978-452-5975
Practice Address - Street 1:9 NORTH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2755
Practice Address - Country:US
Practice Address - Phone:978-458-2005
Practice Address - Fax:978-452-5975
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2017-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA204365207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0168211Medicaid
1079119OtherAETNA PCP
MA9751581Medicaid
J22863OtherBC
69813OtherHARVARD PILGRIM
409950OtherTUFTS
5895545OtherAETNA SPECIALIST
0022852OtherNEIGHBORHOOD HEALTH
3100208OtherUNITED HEALTH CARE
MAPTAN DD7599OtherMEDICARE RAILROAD
51894OtherFALLON
69813OtherHARVARD PILGRIM
69813OtherHARVARD PILGRIM