Provider Demographics
NPI:1386611523
Name:SEON, CARL
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:SEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ARCH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 ARCH ST STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3214
Practice Address - Country:US
Practice Address - Phone:814-333-7109
Practice Address - Fax:814-333-7108
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071982L207X00000X, 207X00000X
WV21562207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017793380001Medicaid
PA1017793380001Medicaid
PA107249Medicare ID - Type Unspecified
PA1017793380001Medicaid