Provider Demographics
NPI:1548308927
Name:SEBASTIANELLI, JOHN ROGER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROGER
Last Name:SEBASTIANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:76 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-5814
Mailing Address - Country:US
Mailing Address - Phone:978-373-8222
Mailing Address - Fax:978-373-8223
Practice Address - Street 1:76 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5814
Practice Address - Country:US
Practice Address - Phone:781-373-8222
Practice Address - Fax:978-373-8223
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA71571103TP0016X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300138OtherMASS PROVIDER NUMBER