Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11013088 | IN |
N | 207QS0010X | Family Doctor - Sports Medicine | 0101268046 | VA |
N | 207QS0010X | Family Doctor - Sports Medicine | 55415 | MN |
NPI | 1033120852 |
---|---|
Provider Name | Dr. Sebastian J Ksionski |
First Address | Lynchburg, VA 24503-2513 |
Second Address | Lynchburg, VA 24503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 03/08/2020 |