Provider Demographics
NPI:1104559855
Name:PROKOP, SEBASTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:PROKOP
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3331 STREET RD STE 140
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2052
Mailing Address - Country:US
Mailing Address - Phone:312-882-7527
Mailing Address - Fax:215-645-0818
Practice Address - Street 1:1201 LANGHORNE NEWTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1295
Practice Address - Country:US
Practice Address - Phone:312-882-7527
Practice Address - Fax:215-645-0818
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT227092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine