Provider Demographics
NPI:1871674697
Name:SEDMED PA
Entity type:Organization
Organization Name:SEDMED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SEDDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-892-1068
Mailing Address - Street 1:700 TILGHMAN DR
Mailing Address - Street 2:SUITE 722
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-0007
Mailing Address - Country:US
Mailing Address - Phone:910-892-1068
Mailing Address - Fax:910-892-4527
Practice Address - Street 1:700 TILGHMAN DR
Practice Address - Street 2:SUITE 722
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-0007
Practice Address - Country:US
Practice Address - Phone:910-892-1068
Practice Address - Fax:910-892-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29663207Q00000X
NC22319208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
203571AMedicare PIN
203539CMedicare PIN