Provider Demographics
NPI: | 1639160963 |
---|---|
Name: | SEIBEL, KATHLEEN M (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KATHLEEN |
Middle Name: | M |
Last Name: | SEIBEL |
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: | PO BOX 751069 |
Mailing Address - Street 2: | ECU PHYSICIANS |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28275-1069 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 905 JOHNS HOPKINS DRIVE |
Practice Address - Street 2: | ECU PHYSICIANS PSYCHIATRIC MEDICINE - OUTPATIENT CLINIC |
Practice Address - City: | GREENVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27834-7225 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-744-1406 |
Practice Address - Fax: | 252-744-2419 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-04 |
Last Update Date: | 2010-11-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 30856 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 75211 | Other | BCBS NC |
NC | 8975211 | Medicaid | |
NC | 990015450 | Other | RAILROAD MEDICARE |
NC | 8975211 | Medicaid | |
NC | 213639D | Medicare PIN |