Provider Demographics
NPI:1487755815
Name:SEBASTIAN, MELINDA (MD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:SEBASTIAN
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 1:6000 STEVENSON AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-823-1735
Mailing Address - Fax:703-823-1736
Practice Address - Street 1:6000 STEVENSON AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-823-1735
Practice Address - Fax:703-823-1736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA504719OtherNCPPO
VA6709095Medicaid
VA0735617OtherAETNA
VA285383OtherANTHEM
VA883453OtherOPTM/MAMSI/MDIPA
VA283453OtherALLIANCE
VA288949OtherAMERIGROUP
VA1014518OtherUNITED HEALTHCARE
VA9185OtherCAREFIRST