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NPI Code Detail

MEDICARE: JAMES R SEIBOLD MD

MEDICARE: JAMES R SEIBOLD MD
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
1207RR0500XRheumatology Physician048454CT
2207R00000XInternal Medicine Physician048454CT

General Provider Information

NPI Number : 1821173337
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES R SEIBOLD MD
Provider Business Mailing Address
First Line : 65 KANE ST
Second Line : PROVIDER ENROLLMENT - ELLIE ATKINS
City : WEST HARTFORD
State : CT
Zip : 06119-2110
Country : US
Telephone Number : 860-523-6421
Fax Number : 860-523-3701
Provider Business Practice Location Address
First Line : 263 FARMINGTON AVE
Second Line : MARB MC5353 RM N3020
City : FARMINGTON
State : CT
Zip : 06030-0002
Country : US
Telephone Number : 860-679-3605
Fax Number : 860-679-1042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 05/06/2010

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