Provider Demographics
NPI:1316108541
Name:PUSTILNIK, SEAN D (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:D
Last Name:PUSTILNIK
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 1:600 NORTH WOLFE ST.
Mailing Address - Street 2:CMSC 346, THE CHILDREN'S CENTER, JOHNS HOPKINS HOSP
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-3325
Mailing Address - Country:US
Mailing Address - Phone:410-955-2320
Mailing Address - Fax:
Practice Address - Street 1:600 NORTH WOLFE ST.
Practice Address - Street 2:CMSC 346, THE CHILDREN'S CENTER, JOHNS HOPKINS HOSP
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-3325
Practice Address - Country:US
Practice Address - Phone:410-955-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD748732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program