Provider Demographics
NPI:1730147851
Name:SEIDEL, FREDERICK J (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-1230
Mailing Address - Country:US
Mailing Address - Phone:717-461-6754
Mailing Address - Fax:
Practice Address - Street 1:340 PEAK ONE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:717-461-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051602208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0881316Medicaid
000194618OtherBLUE SHIELD
110233958OtherRR MEDICARE
PAB41064Medicare UPIN
194618D99Medicare PIN
110233958OtherRR MEDICARE