Provider Demographics
NPI:1134101157
Name:SIEBOLD, EARLENE CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:EARLENE
Middle Name:CATHERINE
Last Name:SIEBOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:880 WESTFALL RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2611
Mailing Address - Country:US
Mailing Address - Phone:585-244-5630
Mailing Address - Fax:585-434-4915
Practice Address - Street 1:880 WESTFALL RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2611
Practice Address - Country:US
Practice Address - Phone:585-244-5630
Practice Address - Fax:585-434-4915
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1562872207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01093163Medicaid
NY01093163Medicaid
B77460Medicare UPIN