Healthcare Provider Details

I. General information

NPI: 1366480584
Provider Name (Legal Business Name): STEPHEN J SEBASTIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 FRANKLIN ST
WRENTHAM MA
02093-1232
US

IV. Provider business mailing address

885 FRANKLIN ST
WRENTHAM MA
02093-1232
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2994
  • Fax:
Mailing address:
  • Phone: 978-466-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number75127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: