Provider Demographics
NPI:1194782680
Name:JOHN P SEVASTOS DO & ASSOC INC
Entity type:Organization
Organization Name:JOHN P SEVASTOS DO & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVASTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-751-3280
Mailing Address - Street 1:4002 WARRENSVILLE CTR RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4002 WARRENSVILLE CTR RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6771
Practice Address - Country:US
Practice Address - Phone:216-751-3280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty