Healthcare Provider Details

I. General information

NPI: 1740866441
Provider Name (Legal Business Name): ROY SEBASTIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

V. Phone/Fax

Practice location:
  • Phone: 214-930-7527
  • Fax:
Mailing address:
  • Phone: 410-328-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD0102446
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV5601
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: