Healthcare Provider Details

I. General information

NPI: 1760477756
Provider Name (Legal Business Name): JOHN WADE SEEDOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E CHESTER PK SUITE 4
RIDLEY PARK PA
19078-1709
US

IV. Provider business mailing address

204 E CHESTER PK SUITE 4
RIDLEY PARK PA
19078-1709
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-4677
  • Fax: 610-521-0951
Mailing address:
  • Phone: 610-521-4677
  • Fax: 610-521-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD027831E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: