Healthcare Provider Details

I. General information

NPI: 1548329055
Provider Name (Legal Business Name): MARVIN DAVID SEPPALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ESTHER ST
NEWBERG OR
97132-9529
US

IV. Provider business mailing address

23895 SW NEWLAND RD
WILSONVILLE OR
97070-6704
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-4334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD15805
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: