Provider Demographics
NPI:1063711554
Name:SIEGEL, BRIANNA SCHUMAN
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SCHUMAN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 LONG RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-348-9455
Mailing Address - Fax:203-348-9183
Practice Address - Street 1:292 LONG RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-348-9455
Practice Address - Fax:203-348-9183
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine