MEDICARE: DR. RICHARD C SEESTEDT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084V0102X	Vascular Neurology Physician	0101840424	VA
2	2084N0400X	Neurology Physician	0101840424	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104895630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C SEESTEDT M.D.

Provider Business Mailing Address
First Line	:	3020 HAMAKER CT
Second Line	:	SUITE 400
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2238
Country	:	US
Telephone Number	:	703-876-0800
Fax Number	:	703-876-0866

Provider Business Practice Location Address
First Line	:	3020 HAMAKER CT
Second Line	:	SUITE 400
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2238
Country	:	US
Telephone Number	:	703-876-0800
Fax Number	:	703-876-0866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	05/31/2022

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