Provider Demographics
NPI:1124054457
Name:SEBASTIAN, MARY LOUISE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1625 N GEORGE MASON DR STE 315
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3690
Mailing Address - Country:US
Mailing Address - Phone:703-717-4217
Mailing Address - Fax:703-717-4218
Practice Address - Street 1:1625 N GEORGE MASON DR STE 315
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3690
Practice Address - Country:US
Practice Address - Phone:703-717-4217
Practice Address - Fax:703-717-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-01-20
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Provider Licenses
StateLicense IDTaxonomies
VA0101233396208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery