Provider Demographics
NPI:1609948256
Name:SIEGEL, SHARON G (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD150692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2323490OtherAETNA USHC
MEMM7675Medicare ID - Type Unspecified
MEG58430OtherHPHC
MEG58430Medicare UPIN
ME302800099Medicaid
MEMM767502Medicare PIN
MEM150397OtherCIGNA
ME0005320759OtherAETNA
NH01Y007911ME01OtherANTHEM
MEMM767501Medicare PIN
NH30200118Medicaid
NHKX0267Medicare PIN
ME037096OtherANTHEM
ME300096966Medicare ID - Type UnspecifiedRAILROAD
NHRE8101Medicare ID - Type Unspecified