Provider Demographics
NPI:1578525242
Name:SEIDNER-JOSEPH, ELYSE L (MD)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:L
Last Name:SEIDNER-JOSEPH
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 1:520 WILLIAM EBBS LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5210
Mailing Address - Country:US
Mailing Address - Phone:484-947-6806
Mailing Address - Fax:484-947-6806
Practice Address - Street 1:520 WILLIAM EBBS LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:484-947-6806
Practice Address - Fax:484-947-6806
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049138L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014214550005Medicaid
E94789Medicare UPIN
PA0014214550005Medicaid