Basic Information
| Provider Information | |||||||||
| NPI: | 1275820839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIEGELE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | WOOD | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOOD | ||||||||
| OtherFirstName: | CAROLYN | ||||||||
| OtherMiddleName: | VIRGINIA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1003 PROVIDENCE DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971327521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035382698 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1003 PROVIDENCE DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971327521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035382698 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 06/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0116023860 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD172038 | OR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.