Provider Demographics
NPI:1184780546
Name:SEAMON, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SEAMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:MOB 1ST FLOOR, SUITE 120
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-7320
Mailing Address - Fax:215-243-4605
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:MOB 1ST FLOOR, SUITE 120
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-7320
Practice Address - Fax:215-243-4605
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-11-06
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Provider Licenses
StateLicense IDTaxonomies
PAMD4244592086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118910Medicare PIN
NJMA08811800OtherSTATE LICENSE