Provider Demographics
NPI:1821173337
Name:SEIBOLD, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:SEIBOLD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:65 KANE ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - ELLIE ATKINS
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2110
Mailing Address - Country:US
Mailing Address - Phone:860-523-6421
Mailing Address - Fax:860-523-3701
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:MARB MC5353 RM N3020
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0002
Practice Address - Country:US
Practice Address - Phone:860-679-3605
Practice Address - Fax:860-679-1042
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-05-06
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Provider Licenses
StateLicense IDTaxonomies
CT048454207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine