Provider Demographics
NPI:1164664058
Name:SIEGRIST, MARK (OM000182)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SIEGRIST
Suffix:
Gender:M
Credentials:OM000182
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1812
Mailing Address - Country:US
Mailing Address - Phone:484-794-5241
Mailing Address - Fax:
Practice Address - Street 1:3933 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2756
Practice Address - Country:US
Practice Address - Phone:610-779-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist