Provider Demographics
NPI:1578502563
Name:SIEGENBERG, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIEGENBERG
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 1:30 NEW CROSSING RD
Mailing Address - Street 2:SUITE # 310
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3271
Mailing Address - Country:US
Mailing Address - Phone:781-944-1166
Mailing Address - Fax:781-944-1168
Practice Address - Street 1:30 NEWCROSSING RD
Practice Address - Street 2:SUITE # 310
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3271
Practice Address - Country:US
Practice Address - Phone:781-944-1166
Practice Address - Fax:781-944-1168
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74850207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100010853OtherRAILROAD MEDICARE
MAOX2517Medicare PIN
MA100010853OtherRAILROAD MEDICARE
MAJ30199Medicare PIN