Provider Demographics
NPI:1730273509
Name:SEAL, PATRICIA L (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:SEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FARRELL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6112
Mailing Address - Country:US
Mailing Address - Phone:802-864-9522
Mailing Address - Fax:802-859-8928
Practice Address - Street 1:30 FARRELL ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6112
Practice Address - Country:US
Practice Address - Phone:802-864-9522
Practice Address - Fax:802-859-8928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007898207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
47D0091232OtherCLIA #
VT0009366Medicaid
07V005OtherMVP PROVIDER ID #
SEAL00005199OtherBCBS OF VT PROVIDER ID#
47D0091232OtherCLIA #
VT0009366Medicaid