Provider Demographics
NPI:1710016613
Name:SIEGEL, SEYMOUR - (MD)
Entity Type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:-
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 1:1431 ACADEMY LN
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2514
Mailing Address - Country:US
Mailing Address - Phone:215-782-8020
Mailing Address - Fax:215-782-8021
Practice Address - Street 1:1431 ACADEMY LN
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2514
Practice Address - Country:US
Practice Address - Phone:215-782-8020
Practice Address - Fax:215-782-8021
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021408L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine