Healthcare Provider Details

I. General information

NPI: 1417958463
Provider Name (Legal Business Name): ERNEST FREDERICK JOSEPH SIEBOLD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: E. F. JOSEPH SIEBOLD D.O.

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 THE GREEN UNIVERSITY OF DELAWARE, STUDENT HEALTH SERVICE
NEWARK DE
19716-8101
US

IV. Provider business mailing address

41 HIDDEN VALLEY DR
NEWARK DE
19711-7463
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-2226
  • Fax: 302-831-4252
Mailing address:
  • Phone: 302-738-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC2-0000842
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: