Provider Demographics
NPI:1700945128
Name:EATON, SETH R (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:R
Last Name:EATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:8771 SUSINI DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1225
Mailing Address - Country:US
Mailing Address - Phone:301-317-1644
Mailing Address - Fax:
Practice Address - Street 1:7350 VAN DUSEN RD STE 130
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5267
Practice Address - Country:US
Practice Address - Phone:301-498-8880
Practice Address - Fax:301-498-7939
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026556207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94828Medicare UPIN