Individual provider Active NPI

Paul J Sedacca, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1982688115
Registry record updated Feb 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD021092E Issued in PA
Practice address
2300 S Broad St
Philadelphia, PA 19145-4417
Phone
(215) 463-2100
Fax
(215) 463-6619
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD021092E PA Primary

Addresses

Primary practice location

2300 S Broad St
Philadelphia, PA 19145-4417

Mailing address

2300 S Broad St
Philadelphia, PA 19145-4417
Phone (215) 463-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080327000235 PA Practitioner - Internal Medicine 6204912512 Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD021092EPAMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202947200000",
    "number": "1982688115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191454417",
            "telephone_number": "215-463-2100",
            "fax_number": "215-463-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191454417",
            "telephone_number": "215-463-2100",
            "fax_number": "215-463-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEDACCA",
        "first_name": "PAUL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2008-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD021092E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.