MEDICARE: DR. SEAN XIAO LUO MD, PHD

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	2084P0802X	Addiction Psychiatry Physician	261934	NY
2	2084P0800X	Psychiatry Physician	261934	NY

General Provider Information

NPI Number	:	1205153723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN XIAO LUO MD, PHD

Provider Business Mailing Address
First Line	:	215 W 88TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	646-918-3780
Fax Number	:	646-786-3772

Provider Business Practice Location Address
First Line	:	215 W 88TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	646-918-3780
Fax Number	:	646-786-3772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	09/27/2024

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