Provider Demographics
NPI:1043204662
Name:RODDY, SEAN PETER (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PETER
Last Name:RODDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:391 MYRTLE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3797
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:391 MYRTLE AVE., SUITE 5
Practice Address - Street 2:THE VASCULAR GROUP, PLLC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5640
Practice Address - Fax:518-262-9413
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2147442085R0204X, 208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01991111Medicaid
NY01991111Medicaid
NY097Y0220Medicare ID - Type UnspecifiedDOWNSTATE
NYRAO688Medicare ID - Type Unspecified