Provider Demographics
NPI:1669436085
Name:SEDA, CHRISTOPHER ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:SEDA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 HELEN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7456
Mailing Address - Country:US
Mailing Address - Phone:717-273-6040
Mailing Address - Fax:
Practice Address - Street 1:840 HELEN DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5300
Practice Address - Country:US
Practice Address - Phone:717-273-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004784L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012142740002OtherDEPT PUBLIC WELFARE #
PA1547574OtherMEDICARE ASSURED #
PA075304HP6Medicare PIN
PA075304Medicare PIN
PA1547574OtherMEDICARE ASSURED #