Provider Demographics
NPI:1689773830
Name:SIEGEL, M. BARRY (MD)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:BARRY
Last Name:SIEGEL
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 1:1220 SOM CENTER RD
Mailing Address - Street 2:# D
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2002
Mailing Address - Country:US
Mailing Address - Phone:440-720-0790
Mailing Address - Fax:440-720-0786
Practice Address - Street 1:1220 SOM CENTER RD
Practice Address - Street 2:# D
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2002
Practice Address - Country:US
Practice Address - Phone:440-710-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029393S207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0486522Medicaid
OH0486522Medicaid
OH0512284Medicare ID - Type Unspecified