Provider Demographics
NPI:1639392236
Name:FINNERTY, SEAN LAWRENCE (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:LAWRENCE
Last Name:FINNERTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROSELAND AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5997
Mailing Address - Country:US
Mailing Address - Phone:973-444-0177
Mailing Address - Fax:
Practice Address - Street 1:801 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3636
Practice Address - Country:US
Practice Address - Phone:302-629-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0008470207P00000X
NJ25MB08011400207P00000X
MDH68559207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414097400Medicaid
DE1639392236Medicaid
DE1639392236OtherBC/BS
DE1639392236OtherBC/BS