Healthcare Provider Details

I. General information

NPI: 1578552006
Provider Name (Legal Business Name): DAVID W SEAMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CLEVELAND AVE SUITE 14
MARTINSVILLE VA
24112-2937
US

IV. Provider business mailing address

15 CLEVELAND AVE SUITE 14
MARTINSVILLE VA
24112-2937
US

V. Phone/Fax

Practice location:
  • Phone: 276-632-9714
  • Fax: 276-632-0620
Mailing address:
  • Phone: 276-632-9714
  • Fax: 276-632-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101044935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: