Provider Demographics
NPI:1710277843
Name:SEIDELMANN, SARA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SEIDELMANN
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 1:644 W PUTNAM AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6088
Mailing Address - Country:US
Mailing Address - Phone:203-661-2596
Mailing Address - Fax:203-625-8331
Practice Address - Street 1:644 W PUTNAM AVE STE 203
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6088
Practice Address - Country:US
Practice Address - Phone:203-661-2596
Practice Address - Fax:203-625-8331
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61870207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty