Provider Demographics
NPI:1578547287
Name:SIEGELBAUM, MARC HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:HOWARD
Last Name:SIEGELBAUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:STE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:410-296-0167
Mailing Address - Fax:410-296-0099
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:STE 506
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-296-0167
Practice Address - Fax:410-296-0099
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-04-24
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Provider Licenses
StateLicense IDTaxonomies
MDD0028348208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211501800Medicaid
MD731LO257Medicare PIN
MD211501800Medicaid