Provider Demographics
NPI:1609956432
Name:MARC M. SEDWITZ, M.D., INC.
Entity Type:Organization
Organization Name:MARC M. SEDWITZ, M.D., INC.
Other - Org Name:PACIFIC COAST VASCULAR AND GENERAL SURGERY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEDWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-452-0306
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-452-0306
Mailing Address - Fax:858-452-1421
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-452-0306
Practice Address - Fax:858-452-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0076800Medicaid
CAGR0076800Medicaid
CA5822240001Medicare NSC