Healthcare Provider Details

I. General information

NPI: 1952319139
Provider Name (Legal Business Name): ALAN P SIEGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WASHINGTON AVENUE SUITE 203 GERIATRIC AND ADULT PSYCHIATRY LLC
HAMDEN CT
06518-3272
US

IV. Provider business mailing address

60 WASHINGTON AVENUE SUITE 203 GERIATRIC AND ADULT PSYCHIATRY LLC
HAMDEN CT
06518-3272
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-0414
  • Fax: 203-288-3655
Mailing address:
  • Phone: 203-288-0414
  • Fax: 203-288-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number022695
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number022695
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: