Healthcare Provider Details

I. General information

NPI: 1538212477
Provider Name (Legal Business Name): SEAMUS MARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 MAIN STREET SUITE 205
MILLIS MA
02054
US

IV. Provider business mailing address

969 MAIN STREET SUITE 205
MILLIS MA
02054
US

V. Phone/Fax

Practice location:
  • Phone: 508-376-3000
  • Fax: 508-376-3024
Mailing address:
  • Phone: 508-376-3000
  • Fax: 508-376-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number238902
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: