Provider Demographics
NPI:1962551804
Name:SEBASTIAN, PATRICIA L (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3260 75 RT 2
Mailing Address - Street 2:MANSHANTUCKET PEQUOT TRIBAL HEALTH DEPT.
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06338-3260
Mailing Address - Country:US
Mailing Address - Phone:860-312-8000
Mailing Address - Fax:860-312-8001
Practice Address - Street 1:75 RT 2
Practice Address - Street 2:MANSHANTUCKET PEQUOT TRIBAL HEALT SERVICES
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06338-3260
Practice Address - Country:US
Practice Address - Phone:860-312-8000
Practice Address - Fax:860-312-8001
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD42618207Q00000X, 208000000X
CTD42618208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF75325Medicare UPIN