Provider Demographics
NPI:1083762181
Name:DE SIEYES, CHARLES JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:DE SIEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:JOSEPH
Other - Last Name:DE SIEYES M.D. P.A. LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:35 OLD POWERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1615
Mailing Address - Country:US
Mailing Address - Phone:207-749-1716
Mailing Address - Fax:207-781-7053
Practice Address - Street 1:202 US ROUTE 1
Practice Address - Street 2:SUITE 200
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1121
Practice Address - Country:US
Practice Address - Phone:207-781-4488
Practice Address - Fax:207-781-4470
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDO3767Medicare UPIN