Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 60796 | CT |
NPI | 1013301134 |
---|---|
Provider Name | Samantha Siegel |
First Address | New Haven, CT 06510-3206 |
Second Address | New Haven, CT 06510-3206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 13/02/2019 |