Provider Demographics
NPI:1497861587
Name:SIEGEL, JUDSON LEWIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:LEWIS
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MATTHEW ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-475-3531
Mailing Address - Fax:508-460-9728
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:STE 405
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-481-3659
Practice Address - Fax:508-460-9728
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2090213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0316610Medicaid
U66942Medicare UPIN
MAY75037Medicare ID - Type Unspecified