Provider Demographics
NPI:1104973213
Name:SEWELL, THOMAS L (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:SEWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3834
Mailing Address - Country:US
Mailing Address - Phone:410-822-8773
Mailing Address - Fax:410-822-4330
Practice Address - Street 1:506 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3847
Practice Address - Country:US
Practice Address - Phone:410-822-8773
Practice Address - Fax:410-822-4330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1043213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1372693OtherCIGNA
MD73186OtherCOVENTRY
MD312921OtherUNITEDHEALTHCARE MAMSI
MD521835787OtherCAREFIRST BCBS MARYLAND
MD100470Medicaid
MD550268300Medicaid
MDE589-0001OtherBLUECHOICE BCBS
MD108481Medicaid
MD521835787Medicaid
MD5924246OtherAETNA
MD480014675Medicare PIN
MDT197Medicare PIN
MDE589-0001OtherBLUECHOICE BCBS
MDT90514Medicare UPIN