Provider Demographics
NPI:1932128592
Name:SEIDENSTICKER, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:SEIDENSTICKER
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 1:100 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2420
Mailing Address - Country:US
Mailing Address - Phone:740-779-8268
Mailing Address - Fax:740-779-8269
Practice Address - Street 1:100 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2420
Practice Address - Country:US
Practice Address - Phone:740-779-8268
Practice Address - Fax:740-779-8269
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.025264207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091556Medicaid
OHSE7277991Medicare ID - Type Unspecified
OHA70690Medicare UPIN