Healthcare Provider Details

I. General information

NPI: 1508856428
Provider Name (Legal Business Name): THOMAS MARK SEQUEIRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2005
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 MAYFIELD RD SUITE 412
MAYFIELD HEIGHTS OH
44124-2271
US

IV. Provider business mailing address

6803 MAYFIELD RD SUITE 412
MAYFIELD HEIGHTS OH
44124-2271
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-7300
  • Fax: 440-442-9019
Mailing address:
  • Phone: 440-442-7300
  • Fax: 440-442-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35039830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: