Healthcare Provider Details

I. General information

NPI: 1659281335
Provider Name (Legal Business Name): SETON MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 EDMONDSON AVE STE 2
BALTIMORE MD
21229-1506
US

IV. Provider business mailing address

4500 EDMONDSON AVE STE 2
BALTIMORE MD
21229-1506
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-4500
  • Fax: 667-234-4501
Mailing address:
  • Phone: 667-234-4500
  • Fax: 667-234-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SIENNA CARTER
Title or Position: ENROLLMENT SUPERVISOR
Credential:
Phone: 850-207-0025