Healthcare Provider Details

I. General information

NPI: 1255130704
Provider Name (Legal Business Name): SETON MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

900 CATON AVE
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-2626
  • Fax:
Mailing address:
  • Phone: 667-234-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM B HIGGINGBOTHAM
Title or Position: PRESIDENT/CEO
Credential:
Phone: 667-234-3162