Provider Demographics
NPI:1558462135
Name:SIEGEL, BARY J (MD)
Entity Type:Individual
Prefix:
First Name:BARY
Middle Name:J
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-733-8725
Practice Address - Fax:916-733-8770
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG52975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G529750Medicaid
CA00G529753Medicare PIN
00G529750Medicare ID - Type Unspecified
CA00G529750Medicaid