Provider Demographics
NPI:1386680569
Name:SIEGEL, ALYSSA D (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:D
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3550 MARKET ST FL 4
Practice Address - Street 2:CHOP CARE NETWORK AT MARKET STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3368
Practice Address - Country:US
Practice Address - Phone:215-590-2178
Practice Address - Fax:215-590-4619
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8686505Medicaid
PA0018733000004Medicaid
NJ8686505Medicaid
PA0018733000004Medicaid