Healthcare Provider Details

I. General information

NPI: 1356492474
Provider Name (Legal Business Name): SEBASTIANO DIDATO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MERRIAM AVE STE 101
LEOMINSTER MA
01453-3175
US

IV. Provider business mailing address

114 MERRIAM AVE STE 101
LEOMINSTER MA
01453-3175
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-3399
  • Fax:
Mailing address:
  • Phone: 978-534-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number241680
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number17558
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17558
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: