Provider Demographics
NPI:1801849484
Name:SIMPSON-SEBASTIANO, LAURIE LYNN (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LYNN
Last Name:SIMPSON-SEBASTIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:LYNN
Other - Last Name:SIMPSON-SEBASTIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:95 HIGHLAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9483
Mailing Address - Country:US
Mailing Address - Phone:610-868-1100
Mailing Address - Fax:610-868-1111
Practice Address - Street 1:425 BRIGHTON ST
Practice Address - Street 2:#303
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1273
Practice Address - Country:US
Practice Address - Phone:610-868-1100
Practice Address - Fax:610-868-1111
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070167L2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01807126Medicaid
PA034382Medicare ID - Type Unspecified
PA01807126Medicaid