Basic Information
| Provider Information | |||||||||
| NPI: | 1730155094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELAIR | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1443738287 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7557 DANNAHER DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659385222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | A83740 | CA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 40836 | KY | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD52511 | TN | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | Q015248 | 05 | TN | MEDICAID |