Provider Demographics
NPI:1215933387
Name:SEQUEIRA, REGINALD (MD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:
Last Name:SEQUEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LINCOLN PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6403
Mailing Address - Country:US
Mailing Address - Phone:937-298-8058
Mailing Address - Fax:937-298-5638
Practice Address - Street 1:540 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6401
Practice Address - Country:US
Practice Address - Phone:937-298-8058
Practice Address - Fax:937-298-5638
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069268S207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201674Medicaid
OHG76414Medicare UPIN
OH2201674Medicaid
OH4303621Medicare PIN
OH4303623Medicare PIN
OHP00964843Medicare PIN
OHSE4062439Medicare PIN
4303622Medicare PIN