MEDICARE: RICHARD SIAHAAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	24303	CT
2	207R00000X	Internal Medicine Physician	024303	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004263612	OTHER	CT	CHN
2	0V0438	OTHER	CT	HEALTHNET
3	7294618	OTHER	PA	CIGNA
4	704554	OTHER	CT	CONNECTICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	369877	OTHER	CT	WELLCARE
7	427750	OTHER	MA	TUFTS
8	80705	OTHER	CT	GREATWEST
9	010024303CT01	OTHER	CT	BLUESHIELD
10	514837	OTHER	TX	AETNA
11	P3592661	OTHER	CT	OXFORD
12	1751515	OTHER	GA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1013133628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD SIAHAAN M.D.

Provider Business Mailing Address
First Line	:	421 COTTAGE GROVE RD
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3170
Country	:	US
Telephone Number	:	860-242-0034
Fax Number	:	860-242-3301

Provider Business Practice Location Address
First Line	:	421 COTTAGE GROVE RD
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3170
Country	:	US
Telephone Number	:	860-242-0034
Fax Number	:	860-242-3301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	12/28/2016

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