Healthcare Provider Details

I. General information

NPI: 1144208240
Provider Name (Legal Business Name): ADAM SEIDNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MONTAUK AVE
NEW LONDON CT
06320-4724
US

IV. Provider business mailing address

90 S MAIN ST
MIDDLETOWN CT
06457-3649
US

V. Phone/Fax

Practice location:
  • Phone: 860-344-6300
  • Fax: 860-344-9249
Mailing address:
  • Phone: 860-344-6300
  • Fax: 860-344-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number030901
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number030901
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: