1083762181 NPI number — DR. CHARLES JOSEPH DE SIEYES M.D.

Table of content: DR. CHARLES JOSEPH DE SIEYES M.D. (NPI 1083762181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083762181 NPI number — DR. CHARLES JOSEPH DE SIEYES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE SIEYES
Provider First Name:
CHARLES
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE SIEYES M.D. P.A. LLC
Provider Other First Name:
CHARLES
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1083762181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 OLD POWERHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04105-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-749-1716
Provider Business Mailing Address Fax Number:
207-781-7053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 US ROUTE 1
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04105-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-781-4488
Provider Business Practice Location Address Fax Number:
207-781-4470
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  10240 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com