Provider Demographics
NPI:1760477756
Name:SEEDOR, JOHN WADE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WADE
Last Name:SEEDOR
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 1:204 E CHESTER PK
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1709
Mailing Address - Country:US
Mailing Address - Phone:610-521-4677
Mailing Address - Fax:610-521-0951
Practice Address - Street 1:204 E CHESTER PK
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1709
Practice Address - Country:US
Practice Address - Phone:610-521-4677
Practice Address - Fax:610-521-0951
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027831E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA55442OtherAETNA
PA195833OtherBLUE SHIELD
PA20-3370210OtherTAX ID
PA0055283000OtherKEYSTONE
PA1031213OtherKEYSTONE MERCY
PA110075785OtherTRAVELERS MEDICARE
PAC33268OtherNEIC
PAC33268OtherNEIC
PAC33268Medicare UPIN