Healthcare Provider Details

I. General information

NPI: 1154476125
Provider Name (Legal Business Name): JUDITH J SEAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MEDICAL PARK LOOP STE 501
SYLVA NC
28779-5222
US

IV. Provider business mailing address

186 MEDICAL PARK LOOP STE 501
SYLVA NC
28779-5222
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-5594
  • Fax: 828-586-3040
Mailing address:
  • Phone: 828-586-5594
  • Fax: 828-586-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32570
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8975102
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: