Provider Demographics
NPI:1639184518
Name:SIEGAL, JUSTIN AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:AARON
Last Name:SIEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-129822085N0700X, 2085R0202X
WAMD000420382085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS7398683OtherAETNA/USHS PIN
WA234770OtherLNI-KING COUNTY
WA341472OtherLNI OUTSIDE KING COUNTY
MT1639184518OtherMONTANA DSHS
WA0039587OtherL&I
WA3445SIOtherREGENCE
WA1015172Medicaid
WA8861178Medicare PIN
WA341472OtherLNI OUTSIDE KING COUNTY
WA0039587OtherL&I
WAG8940731Medicare PIN
WA3445SIOtherREGENCE
WAG8940311Medicare PIN