Provider Demographics
NPI:1417093683
Name:FREDERICK E. SIEFERT, MD, PC
Entity Type:Organization
Organization Name:FREDERICK E. SIEFERT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIEFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-637-5406
Mailing Address - Street 1:8 W END AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1642
Mailing Address - Country:US
Mailing Address - Phone:203-637-5406
Mailing Address - Fax:203-637-5408
Practice Address - Street 1:8 W END AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1642
Practice Address - Country:US
Practice Address - Phone:203-637-5406
Practice Address - Fax:203-637-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty