Patricia L Sebastian, MD.
Individual provider Active NPI Pediatrics Physician · Ledyard, CT
NPI 1962551804 · NPPES record last updated Nov 2, 2012
Key facts
- NPI
- 1962551804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- D42618 (CT)
- Practice address
- 75 RT 2
Manshantucket Pequot Tribal Healt Services
Ledyard, CT 06338-3260 - Phone
- (860) 312-8000
- Fax
- (860) 312-8001
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191024002485 | RI | Practitioner - Internal Medicine |
3476771395 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D42618 | CT | MD | Pediatrics Physician |
| D42618 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Narragansett Indian Tribe | Current |
Accepting new patients | |
| Mashantucket Pequot Tribal Nation Health Center | Past |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
51 Old Mill Rd
Charlestown, RI 02813
Phone (401) 364-1263
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | D42618 | MD | |
| Pediatrics Physician | 208000000X | D42618 | MD | |
| Pediatrics Physician | 208000000X | D42618 | CT | Yes |
| Family Medicine Physician | 207Q00000X | D42618 | CT |
Addresses
Primary practice location
75 RT 2
Manshantucket Pequot Tribal Healt Services
Ledyard, CT 06338-3260
Mailing address
PO Box 3260 75 RT 2
Manshantucket Pequot Tribal Health Dept.
Ledyard, CT 06338-3260
Phone (860) 312-8000
Other providers in Ledyard, CT
- Caitlyn Elizabeth Ogilvie
- Pieced Together Therapeutic Associates, LLC
- PO-Cheng Tsai DMD, LLC
- Marilyn Andersen Richard
- Lauren Richardson
- Adam Dickinson Snook
- Sound Medical Associates, PC
- Jennifer F Thomasson
- Town of Ledyard
- Dianne Tracey-Winicki
All providers in Ledyard, CT · Pediatrics Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.