Healthcare Provider Details

I. General information

NPI: 1558343129
Provider Name (Legal Business Name): SEBASTIAN G SEPULVEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NORTH RD SUITE 101
CHELMSFORD MA
01824-2755
US

IV. Provider business mailing address

9 NORTH RD SUITE 101
CHELMSFORD MA
01824-2755
US

V. Phone/Fax

Practice location:
  • Phone: 978-458-2005
  • Fax: 978-452-5975
Mailing address:
  • Phone: 978-458-2005
  • Fax: 978-452-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number204365
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: