Healthcare Provider Details

I. General information

NPI: 1821095084
Provider Name (Legal Business Name): ELIZABETH MARYA SEYMOUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2005
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

2529 BROAD AVE
ALTOONA PA
16601-1912
US

IV. Provider business mailing address

2529 BROAD AVE
ALTOONA PA
16601-1912
US

V. Phone/Fax

Practice location:
  • Phone: 814-944-3569
  • Fax: 814-944-8201
Mailing address:
  • Phone: 814-944-3569
  • Fax: 814-944-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD418861
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: