Provider Demographics
NPI:1437536463
Name:SIEGEL, MARK JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
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 1:570 LONG POINT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7940
Mailing Address - Country:US
Mailing Address - Phone:843-881-0320
Mailing Address - Fax:843-881-5453
Practice Address - Street 1:169 ASHLEY AVE
Practice Address - Street 2:ROOM 202 MAIN HOSPITAL MUSC333
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-3876
Practice Address - Fax:843-876-1435
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38050207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC38050OtherMEDICAL LICENSE
SC380509Medicaid