Provider Demographics
NPI:1760590400
Name:JOHN, SEBASTIAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:K
Last Name:JOHN
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 1:3023 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3902
Mailing Address - Country:US
Mailing Address - Phone:410-732-9317
Mailing Address - Fax:410-732-0731
Practice Address - Street 1:3023 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3902
Practice Address - Country:US
Practice Address - Phone:410-732-9317
Practice Address - Fax:410-732-0731
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD277400300Medicaid
MD163RMedicare ID - Type Unspecified
MDH04424Medicare UPIN