Provider Demographics
NPI:1891992194
Name:SEPULVEDA & ASSOCIATES, PC
Entity Type:Organization
Organization Name:SEPULVEDA & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-458-2005
Mailing Address - Street 1:9 NORTH ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2710
Mailing Address - Country:US
Mailing Address - Phone:978-458-2005
Mailing Address - Fax:
Practice Address - Street 1:9 NORTH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2755
Practice Address - Country:US
Practice Address - Phone:978-458-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21683OtherMEDICARE GROUP
MAM18978OtherBLUE CROSS
MA9751581Medicaid