Provider Demographics
NPI:1003892001
Name:SIEGEL, LYDIA C (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:C
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CYPRESS STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:857-307-3300
Mailing Address - Fax:857-307-3305
Practice Address - Street 1:301 SOUTH HUNTINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:857-307-3300
Practice Address - Fax:857-307-3305
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226444207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2119064Medicaid
0X2104Medicare PIN
MA2119064Medicaid