Provider Demographics
NPI:1073543898
Name:SIEGAL, TODD LORING (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LORING
Last Name:SIEGAL
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 1:1 COOPER PLZ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-342-2380
Mailing Address - Fax:856-365-0472
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERSITY RADIOLOGY, PC
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2383
Practice Address - Fax:856-365-0472
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068149002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0312086000OtherAMERIHEALTH/KEYSTON/IBC
NJ26431OtherUNIVERSITY HEALTH PLAN
NJ010005634OtherAMERICHOICE
NJ3342286OtherAETNA
NJ1556420OtherUNITED HEALTHCARE
NJ519079OtherAMERIHEALTH PPO/IBC
NJ519079OtherPA BS HIGHMARK
NJ60002992OtherHORIZON NJ HEALTH
NJ6282105Medicaid
NJ8152753OtherCIGNA
NJP3737796OtherOXFORD
NJ26431OtherUNIVERSITY HEALTH PLAN
NJ60002992OtherHORIZON NJ HEALTH