Provider Demographics
NPI:1518901545
Name:SIEGEL, ROBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 INNOVATION DR
Mailing Address - Street 2:STE. 2000
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5253
Mailing Address - Country:US
Mailing Address - Phone:864-603-6300
Mailing Address - Fax:864-603-6160
Practice Address - Street 1:1475 KISKER RD STE 180
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8786
Practice Address - Country:US
Practice Address - Phone:636-442-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36631207RH0003X
MO2022039164207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC366311Medicaid
CT001305722Medicaid
SCSC30068157Medicare PIN
CTC90596Medicare UPIN