Provider Demographics
NPI:1285664169
Name:SIEMENS, CHARLOTTE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:A
Last Name:SIEMENS
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 1:1901 E 1ST ST; PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0467
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6490
Practice Address - Street 1:1901 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-0467
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:316-284-6490
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND 64392084P0800X
ND64392084P0804X
KS04-223682084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND013505OtherBSBC OF ND PIN
F14833Medicare UPIN
NDN721923Medicare PIN
ND013505OtherBSBC OF ND PIN
NDN721925Medicare PIN