Provider Demographics
NPI:1215958129
Name:SEELIG, CHARLES B (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:SEELIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 PERRYRIDGE RD
Mailing Address - Street 2:MEDICAL EDUCATION
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4608
Mailing Address - Country:US
Mailing Address - Phone:203-863-3913
Mailing Address - Fax:203-863-3924
Practice Address - Street 1:5 PERRYRIDGE RD
Practice Address - Street 2:MEDICAL EDUCATION
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4608
Practice Address - Country:US
Practice Address - Phone:203-863-3913
Practice Address - Fax:203-863-3924
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT034300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D17277Medicare UPIN
CT110005823Medicare ID - Type Unspecified