Provider Demographics
NPI:1134145808
Name:SIELING, BETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:SIELING
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 1:56 FRANKLIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-709-8882
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:33 BULLET HILL RD.
Practice Address - Street 2:SUITE 214
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4699
Practice Address - Country:US
Practice Address - Phone:203-267-1563
Practice Address - Fax:203-267-1583
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001436949Medicaid
CT020001642Medicare PIN
CTI40856Medicare UPIN