Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 61686 | CT |
N | 2080P0208X | Pediatric Infectious Diseases | 61686 | CT |
NPI | 1598793101 |
---|---|
Provider Name | George Siberry |
First Address | New Haven, CT 06519-1304 |
Second Address | New Haven, CT 06519-1304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1598793101 | (05) | CT |
H07674 | (02) | MD |