Healthcare Provider Details

I. General information

NPI: 1518161918
Provider Name (Legal Business Name): RICHARD G. SEDLAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

8571 INDIAN SPRINGS RD
FREDERICK MD
21702-2325
US

V. Phone/Fax

Practice location:
  • Phone: 703-806-4576
  • Fax: 703-805-8344
Mailing address:
  • Phone: 301-526-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number6450
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number6450
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: