MEDICARE: THOMAS M SEAWORTH 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	207Q00000X	Family Medicine Physician	35090	MN

General Provider Information

NPI Number	:	1750302972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M SEAWORTH MD

Provider Business Mailing Address
First Line	:	20 CENTENNIAL 84 DR W
Second Line	:
City	:	NEW YORK MILLS
State	:	MN
Zip	:	56567
Country	:	US
Telephone Number	:	218-385-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 CENTENNIAL 84 DR W
Second Line	:
City	:	NEW YORK MILLS
State	:	MN
Zip	:	56567
Country	:	US
Telephone Number	:	218-385-2555
Fax Number	:

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	05/10/2012

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