Provider Demographics
NPI:1174731137
Name:SEBOROWSKI, NINA (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:SEBOROWSKI
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 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-468-6171
Mailing Address - Fax:301-468-6172
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE # 307
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-468-6171
Practice Address - Fax:301-468-6172
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00508682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG34041Medicare UPIN