Healthcare Provider Details

I. General information

NPI: 1720253289
Provider Name (Legal Business Name): DAVID PHILLIPS SIEBENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOORE DRIVE GLAXOSMITHKLINE
RESEARCH TRIANGLE PARK NC
27709-3398
US

IV. Provider business mailing address

1603 CLAYMORE RD
CHAPEL HILL NC
27516-9095
US

V. Phone/Fax

Practice location:
  • Phone: 919-483-4816
  • Fax:
Mailing address:
  • Phone: 919-929-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29870
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number29870
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: