Provider Demographics
NPI:1043570534
Name:SIEWE, ERIC ARMAND
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ARMAND
Last Name:SIEWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6093
Mailing Address - Country:US
Mailing Address - Phone:240-463-2298
Mailing Address - Fax:
Practice Address - Street 1:1501 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-6093
Practice Address - Country:US
Practice Address - Phone:240-463-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2853321374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide