Provider Demographics
NPI:1366435752
Name:EKBOTE, SEEMA
Entity type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:EKBOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:ATTN PROVIDER ENROLLMENT
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:724-986-0698
Mailing Address - Fax:814-372-2676
Practice Address - Street 1:1163 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1013
Practice Address - Country:US
Practice Address - Phone:724-258-1841
Practice Address - Fax:724-258-1646
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063742L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102133401 0001Medicaid
PA073877KCQMedicare PIN
PAH95539Medicare UPIN
PAEK073877Medicare ID - Type Unspecified