Provider Demographics
NPI:1023080298
Name:SIELSKI, RICHARD B (MD,)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:SIELSKI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-687-0303
Mailing Address - Fax:740-687-5898
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-687-0303
Practice Address - Fax:740-687-5898
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH053851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699696Medicaid
OHSI0613895Medicare PIN
OH0699696Medicaid