Provider Demographics
NPI:1023094653
Name:SEDER, JEFFREY D (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:SEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL CAMPUS DR NW STE 203
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4094
Mailing Address - Country:US
Mailing Address - Phone:910-755-7192
Mailing Address - Fax:910-755-7194
Practice Address - Street 1:20 MEDICAL CAMPUS DR NW STE 203
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4094
Practice Address - Country:US
Practice Address - Phone:910-755-7192
Practice Address - Fax:910-755-7194
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35196174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2207970OtherUNITED HEALTHCARE
NC561776208BOtherCIGNA HEALTHCARE
NC8975177Medicaid
NC75177OtherBLUE CROSS BLUE SHIELD
NC2169659CMedicare PIN
NC561776208BOtherCIGNA HEALTHCARE
NCE02506Medicare UPIN
FLBP786ZMedicare UPIN