Healthcare Provider Details

I. General information

NPI: 1609934975
Provider Name (Legal Business Name): RAYMOND TETSUO SEKIGUCHI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 LAKE AVE
GREENWICH CT
06830
US

IV. Provider business mailing address

49 LAKE AVE
GREENWICH CT
06830
US

V. Phone/Fax

Practice location:
  • Phone: 203-552-9037
  • Fax: 203-552-9048
Mailing address:
  • Phone: 203-552-9037
  • Fax: 203-552-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035655
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number205086 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: