Provider Demographics
NPI:1023017928
Name:SIEGEL, LEWIS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:ALAN
Last Name:SIEGEL
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 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-332-5168
Mailing Address - Fax:540-332-5875
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:HEART & VASCULAR CENTER, 2ND FLR
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-245-7080
Practice Address - Fax:540-245-7081
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013476207RC0000X
LAMD.013476207RC0000X, 207RI0011X
LA13476207RC0000X
VA0101259587207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1320579Medicaid
LA060016777OtherMEDICARE RAILROAD
MS00015081Medicaid
MS00015081Medicaid
LA5K529Medicare PIN
LAB60923Medicare UPIN
LA060016777Medicare UPIN