Healthcare Provider Details

I. General information

NPI: 1497850135
Provider Name (Legal Business Name): NATHAN A. SEWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 MEADOWBRIDGE RD SUITE 304
MECHANICSVILLE VA
23116-2336
US

IV. Provider business mailing address

8220 MEADOWBRIDGE RD SUITE 304
MECHANICSVILLE VA
23116-2336
US

V. Phone/Fax

Practice location:
  • Phone: 804-427-7770
  • Fax: 804-427-7771
Mailing address:
  • Phone: 804-427-7770
  • Fax: 804-427-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101232933
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: