Provider Demographics
NPI:1447993548
Name:WOMACK, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WOMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ASH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3995
Mailing Address - Country:US
Mailing Address - Phone:248-821-8647
Mailing Address - Fax:
Practice Address - Street 1:521 MOUNT AUBURN ST STE 101
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4153
Practice Address - Country:US
Practice Address - Phone:617-657-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health