Healthcare Provider Details

I. General information

NPI: 1083689152
Provider Name (Legal Business Name): JOHN CALVERT SEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DAFFIN LN
DENTON MD
21629
US

IV. Provider business mailing address

PO BOX 660
DENTON MD
21629
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-2650
  • Fax: 410-479-1626
Mailing address:
  • Phone: 410-479-4306
  • Fax: 410-479-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0011634
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: