Provider Demographics
NPI:1346909694
Name:SIEGWALD, PAUL ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:SIEGWALD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 HARBORSUN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8247
Mailing Address - Country:US
Mailing Address - Phone:843-822-8725
Mailing Address - Fax:
Practice Address - Street 1:1538 HARBORSUN DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-8247
Practice Address - Country:US
Practice Address - Phone:843-822-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant