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General NPI Number Information
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NPI Number | 1790787927
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Entity Type | Individual
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Provider Name | JONATHAN ALAN SEIDENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 2023 PULASKI HIGHWAY
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078
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Country | US
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Telephone | 410-939-6477
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Fax | 410-939-6555
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Provider Business Mailing Address
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Address Line | 2023 PULASKI HIGHWAY
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078
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Country | US
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Telephone | 410-939-6477
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Fax | 410-939-6555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D38724
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License Number State | MD
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