Provider Demographics
NPI:1275820839
Name:SIEGELE, CAROLYN WOOD (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WOOD
Last Name:SIEGELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:VIRGINIA
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 PROVIDENCE DR STE 340
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7521
Mailing Address - Country:US
Mailing Address - Phone:503-538-2698
Mailing Address - Fax:
Practice Address - Street 1:1003 PROVIDENCE DR STE 340
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7521
Practice Address - Country:US
Practice Address - Phone:503-538-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116023860207V00000X
ORMD172038207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology