Provider Demographics
NPI:1154768273
Name:SIEGEL, LILLIAN (CNM)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 DURHAM RD
Mailing Address - Street 2:BIRTH & BEYOND
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2041
Mailing Address - Country:US
Mailing Address - Phone:203-318-8884
Mailing Address - Fax:203-318-8886
Practice Address - Street 1:411 DURHAM RD
Practice Address - Street 2:BIRTH & BEYOND
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2041
Practice Address - Country:US
Practice Address - Phone:203-318-8884
Practice Address - Fax:203-318-8886
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT378367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife