Provider Demographics
NPI:1053348599
Name:SIEPEL, TIMOTHY VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:VINCENT
Last Name:SIEPEL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:8912 HEBDON RD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14171-9741
Mailing Address - Country:US
Mailing Address - Phone:716-942-3219
Mailing Address - Fax:716-942-3977
Practice Address - Street 1:8912 HEBDON RD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14171-9741
Practice Address - Country:US
Practice Address - Phone:716-942-3219
Practice Address - Fax:716-942-3977
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY114398-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
161253463OtherTAX ID
161253463OtherTAX ID