Provider Demographics
NPI:1306929658
Name:WHARTON, SETH W (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:W
Last Name:WHARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 WELLS ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1200
Mailing Address - Country:US
Mailing Address - Phone:518-587-7560
Mailing Address - Fax:518-587-1220
Practice Address - Street 1:7 WELLS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1200
Practice Address - Country:US
Practice Address - Phone:518-587-7560
Practice Address - Fax:518-587-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00896415Medicaid
SW084E8610OtherEMPIRE BLUE CROSS
NY13108OtherMVP
NY000413080001OtherBLUE SHIELD NENY
10002173OtherCDPHP
NY130001846OtherPAMETTO GBA-MEDICARE RR
NY040426007027OtherFIDELIS
NY00896415Medicaid