Provider Demographics
NPI:1992757843
Name:SEAVOLT, MARALYN B (MD)
Entity type:Individual
Prefix:DR
First Name:MARALYN
Middle Name:B
Last Name:SEAVOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARALYN
Other - Middle Name:L
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 ALTAIR PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7647
Mailing Address - Country:US
Mailing Address - Phone:614-898-7546
Mailing Address - Fax:614-794-4294
Practice Address - Street 1:430 ALTAIR PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7647
Practice Address - Country:US
Practice Address - Phone:614-898-7546
Practice Address - Fax:614-794-4294
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075155207N00000X
OH35.075155207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0301429OtherUHC
000000375981OtherANTHEM
7894498OtherAETNA
OH2339955Medicaid
SE4089544Medicare ID - Type Unspecified
7894498OtherAETNA