Provider Demographics
NPI:1144220633
Name:SIEGELBAUM, STEVEN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PETER
Last Name:SIEGELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:PETER
Other - Last Name:SIEGELBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:423 N 21ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2207
Mailing Address - Country:US
Mailing Address - Phone:717-238-3111
Mailing Address - Fax:717-238-1896
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-238-3111
Practice Address - Fax:717-238-1896
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021958E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006270430001Medicaid
PA4255752OtherAETNA US HEALTHCARE
PA50058936OtherCAPITAL BLUE CROSS
PAP00315649OtherRAILROAD MEDICARE
PA091648OtherHIGHMARK BLUE SHIELD
PAB35523OtherHEALTHAMERICA