Provider Demographics
NPI:1578562617
Name:SIEGEL, EVAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:L
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:301-942-3132
Practice Address - Street 1:14995 SHADY GROVE RD STE 250
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:301-942-3521
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038512207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
30647OtherMAMSI
MD52136603OtherCAREFIRST OF MARYLAND
30647OtherALLIANCE
0004330685OtherAETNA
DC0008OtherCAREFIRST OF DC
MD53084100Medicaid
30421OtherPRIORITY PARTNERS
777472OtherUNITED HEALTHCARE
493061OtherNCPPO
89402OtherFIRST HEALTH
MD52136603OtherCAREFIRST OF MARYLAND
DC565436A83Medicare PIN
110030556Medicare PIN