Provider Demographics
NPI:1417958463
Name:SIEBOLD, ERNEST FREDERICK JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ERNEST FREDERICK
Middle Name:JOSEPH
Last Name:SIEBOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:E. F.
Other - Middle Name:JOSEPH
Other - Last Name:SIEBOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:41 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7463
Mailing Address - Country:US
Mailing Address - Phone:302-738-7953
Mailing Address - Fax:
Practice Address - Street 1:282 THE GREEN
Practice Address - Street 2:UNIVERSITY OF DELAWARE, STUDENT HEALTH SERVICE
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-8101
Practice Address - Country:US
Practice Address - Phone:302-831-2226
Practice Address - Fax:302-831-4252
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00008422080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC48258Medicare UPIN