Provider Demographics
NPI:1770547374
Name:SEDMAK, PRIMROSE A (MD)
Entity type:Individual
Prefix:
First Name:PRIMROSE
Middle Name:A
Last Name:SEDMAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 ACKERMAN 3RD FLOOR
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3108
Mailing Address - Country:US
Mailing Address - Phone:614-293-2150
Mailing Address - Fax:614-293-6479
Practice Address - Street 1:3900 STONERIDGE LANE
Practice Address - Street 2:
Practice Address - City:CUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-293-0080
Practice Address - Fax:614-798-7963
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882246Medicaid
OH0882246Medicaid
SE0718567Medicare ID - Type Unspecified