Provider Demographics
NPI:1750490348
Name:SEABRON, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:SEABRON
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 1:7619 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1429
Mailing Address - Country:US
Mailing Address - Phone:202-365-2961
Mailing Address - Fax:202-726-9416
Practice Address - Street 1:7619 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1429
Practice Address - Country:US
Practice Address - Phone:202-365-2961
Practice Address - Fax:202-726-9416
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC13026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC110031264OtherMEDICARE RAILROAD
DC5112OtherBLUE CROSS BLUE SHIELD
DC025275500Medicaid
DC5112OtherBLUE CROSS BLUE SHIELD