MEDICARE: LECIA V SEQUIST MD

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	210902	MA
2	207RX0202X	Medical Oncology Physician	210902	MA

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
2	J28703	OTHER	MA	BCBS MA
3	468218	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1417948316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LECIA V SEQUIST MD

Provider Business Mailing Address
First Line	:	55 FRUIT ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 FRUIT ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2621
Country	:	US
Telephone Number	:	617-724-4000
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/24/2025

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Directions to “ LECIA V SEQUIST MD” Practice Location

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