Provider Demographics
NPI:1376506477
Name:SIEGEL, SANFORD JAY (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:JAY
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:443-738-2889
Mailing Address - Fax:443-738-2713
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-581-1600
Practice Address - Fax:410-581-1603
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32029208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD382821200Medicaid
MD731L578DMedicare PIN
MDD77986Medicare UPIN