Provider Demographics
NPI:1972522381
Name:SEALL, EDWARD A (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:SEALL
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 1:114 EXECUTIVE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4883
Mailing Address - Country:US
Mailing Address - Phone:765-446-0170
Mailing Address - Fax:260-407-8004
Practice Address - Street 1:114 EXECUTIVE DR
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4883
Practice Address - Country:US
Practice Address - Phone:765-446-0170
Practice Address - Fax:260-407-8004
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01051337A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200279810Medicaid
IN809640AAMedicare PIN
IN200279810Medicaid
IN930092785Medicare PIN
INP00273856Medicare PIN
H16650Medicare UPIN