Healthcare Provider Details

I. General information

NPI: 1548235989
Provider Name (Legal Business Name): JEFFREY D SEDLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

108 CONGRESS ST
BELFAST ME
04915-6147
US

V. Phone/Fax

Practice location:
  • Phone: 207-930-6751
  • Fax: 207-338-0197
Mailing address:
  • Phone: 207-505-1120
  • Fax: 203-651-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6894
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number018224
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: