Provider Demographics
NPI:1821057605
Name:SIEGELBAUM, GUNDER & LACEY GASTROENTEROLOGY
Entity Type:Organization
Organization Name:SIEGELBAUM, GUNDER & LACEY GASTROENTEROLOGY
Other - Org Name:SIEGELBAUM, GUNDER & LACEY GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BAISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-238-3111
Mailing Address - Street 1:2626 N 3RD ST
Mailing Address - Street 2:STE.3A
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-2044
Mailing Address - Country:US
Mailing Address - Phone:717-238-3111
Mailing Address - Fax:717-238-1896
Practice Address - Street 1:2626 N 3RD ST
Practice Address - Street 2:STE.3A
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2044
Practice Address - Country:US
Practice Address - Phone:717-238-3111
Practice Address - Fax:717-238-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021958E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty