Provider Demographics
NPI:1558685941
Name:SIEGRIST, MARTIN (PA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SIEGRIST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 EAST AVE
Mailing Address - Street 2:HUTHER-DOYLE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 EAST AVE
Practice Address - Street 2:HUTHER-DOYLE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2638
Practice Address - Country:US
Practice Address - Phone:585-325-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004348363A00000X
NY004348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical