Healthcare Provider Details

I. General information

NPI: 1184647331
Provider Name (Legal Business Name): STACEY L SEIDEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CEDAR LN
COLUMBIA MD
21044-2912
US

IV. Provider business mailing address

500 UPPER CHESAPEAKE DR DEPT. OF EMERGENCY MEDICINE
BEL AIR MD
21014-4324
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-4888
  • Fax: 410-884-4887
Mailing address:
  • Phone: 443-643-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD64555
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: