Provider Demographics
NPI:1609934975
Name:SEKIGUCHI, RAYMOND TETSUO (MD PHD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:TETSUO
Last Name:SEKIGUCHI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-552-9037
Mailing Address - Fax:203-552-9048
Practice Address - Street 1:49 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-552-9037
Practice Address - Fax:203-552-9048
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035655207Q00000X
NY205086 1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
061489070OtherFIRST HEALTH PLAN
CT021058OtherHEALTHNET
5846468OtherAETNA
CT035665OtherCONNECTICARE
6034277002OtherCIGNA
CT010035655CT01OtherANTHEM
CT021058OtherHEALTHNET