Provider Demographics
NPI:1306826656
Name:SIEGEL, EUGENE HERBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:HERBERT
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DO
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 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-342-6777
Mailing Address - Fax:215-722-1259
Practice Address - Street 1:6410A RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-5229
Practice Address - Country:US
Practice Address - Phone:215-342-6777
Practice Address - Fax:215-722-1259
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002616L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101744459Medicaid
PA597586OtherMEDICARE GROUP
PA101744459Medicaid
PA041823Medicare PIN