Provider Demographics
NPI:1902860091
Name:SIEGEL, STEPHEN B (M D)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:M D
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Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TPKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1835
Mailing Address - Country:US
Mailing Address - Phone:203-757-8361
Mailing Address - Fax:203-754-9126
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-440-3093
Practice Address - Fax:303-440-3161
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT040149208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG72535Medicare UPIN