MEDICARE: MARIO J. SEBASTIANELLI, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD006983E	PA
2	207RN0300X	Nephrology Physician	MD006983E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194723007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO J. SEBASTIANELLI, MD PC

Provider Business Mailing Address
First Line	:	1416 MONROE AVE
Second Line	:	STE 206
City	:	DUNMORE
State	:	PA
Zip	:	18509-2477
Country	:	US
Telephone Number	:	570-347-5212
Fax Number	:	570-346-4814

Provider Business Practice Location Address
First Line	:	1416 MONROE AVE
Second Line	:	STE 206
City	:	DUNMORE
State	:	PA
Zip	:	18509-2477
Country	:	US
Telephone Number	:	570-347-5212
Fax Number	:	570-346-4814

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIO J. SEBASTIANELLI
Credential	:	M.D.
Telephone Number	:	570-347-5212

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/06/2007

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