Healthcare Provider Details

I. General information

NPI: 1376570168
Provider Name (Legal Business Name): STEPHEN J SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SHUNPIKE RD
CROMWELL CT
06416
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-5280
  • Fax: 860-358-8650
Mailing address:
  • Phone: 860-358-4870
  • Fax: 860-358-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039774
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: