Provider Demographics
NPI:1730155094
Name:DELAIR, SEAN MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MARTIN
Last Name:DELAIR
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 1:25 CROSSROADS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5437
Mailing Address - Country:US
Mailing Address - Phone:144-373-8287
Mailing Address - Fax:
Practice Address - Street 1:7557 DANNAHER DR STE 230
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849
Practice Address - Country:US
Practice Address - Phone:865-938-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83740208800000X
KY40836208800000X
TNMD52511208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015248Medicaid
TNQ015248Medicaid
KYP400038747Medicare PIN
KY7100014430Medicaid
KYP00423784Medicare PIN