MEDICARE: DR. SEBASTIANO DIDATO 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	208600000X	Surgery Physician	241680	MA
2	2086S0129X	Vascular Surgery Physician	17558	NH
3	208600000X	Surgery Physician	17558	NH

General Provider Information

NPI Number	:	1356492474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEBASTIANO DIDATO M.D.

Provider Business Mailing Address
First Line	:	114 MERRIAM AVE STE 101
Second Line	:
City	:	LEOMINSTER
State	:	MA
Zip	:	01453-3175
Country	:	US
Telephone Number	:	978-534-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 MERRIAM AVE STE 101
Second Line	:
City	:	LEOMINSTER
State	:	MA
Zip	:	01453-3175
Country	:	US
Telephone Number	:	978-534-3399
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/04/2025

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