Provider Demographics
NPI:1437145224
Name:SEELEY, BROOK M (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOK
Middle Name:M
Last Name:SEELEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:499 FARMINGTON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1933
Mailing Address - Country:US
Mailing Address - Phone:860-676-2472
Mailing Address - Fax:860-678-9119
Practice Address - Street 1:499 FARMINGTON AVE.
Practice Address - Street 2:SUITE 210
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-676-2472
Practice Address - Fax:860-678-9119
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040639207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH44742Medicare UPIN