Provider Demographics
NPI: | 1770902892 |
---|---|
Name: | SEAWORTH, HEMA N (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | HEMA |
Middle Name: | N |
Last Name: | SEAWORTH |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | HEMA |
Other - Middle Name: | L |
Other - Last Name: | NAVANEETHAN |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 4502 MEDICAL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78229-4402 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-358-4000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4502 MEDICAL DR |
Practice Address - Street 2: | |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78229-4402 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-358-4000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-04-16 |
Last Update Date: | 2024-10-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 30764 | 208000000X |
MO | 2014019463 | 208000000X |
TX | S9943 | 2080H0002X, 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080H0002X | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 422124403 | Medicaid | |
TX | 422124404 | Other | CSHCN |