Healthcare Provider Details

I. General information

NPI: 1942249370
Provider Name (Legal Business Name): SIDERIS DAVID BAER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CENTRAL ST
IPSWICH MA
01938-1902
US

IV. Provider business mailing address

PO BOX 2190
WEST PEABODY MA
01960-7190
US

V. Phone/Fax

Practice location:
  • Phone: 978-356-4884
  • Fax:
Mailing address:
  • Phone: 781-231-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42200
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: