Provider Demographics
NPI:1679683031
Name:SEEDAT, MOHAMMED S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:S
Last Name:SEEDAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3601
Mailing Address - Country:US
Mailing Address - Phone:315-336-3353
Mailing Address - Fax:315-336-3356
Practice Address - Street 1:1316 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3601
Practice Address - Country:US
Practice Address - Phone:315-336-3353
Practice Address - Fax:315-336-3356
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202800207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02731588Medicaid
NY02731588Medicaid
RA9598Medicare PIN