Provider Demographics
NPI:1598022576
Name:SEBORG, KEVIN M (HAD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:SEBORG
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 YACHTSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3484
Mailing Address - Country:US
Mailing Address - Phone:443-475-2316
Mailing Address - Fax:
Practice Address - Street 1:963 YACHTSMAN WAY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3484
Practice Address - Country:US
Practice Address - Phone:443-475-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02703237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist