Provider Demographics
NPI:1851459093
Name:SIEGAL, CAROLYN LIANE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:LIANE
Last Name:SIEGAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 PROVIDENCE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-278-5635
Mailing Address - Fax:781-440-7585
Practice Address - Street 1:1177 PROVIDENCE HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-278-5635
Practice Address - Fax:781-440-7585
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4248213ES0131X
MA2308213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0729507Medicaid
CAE4248OtherCA LICENSE #
MA2308OtherMA MEDICAL LICENSE #
CAU81643Medicare UPIN
CAE4248Medicare UPIN
MA0729507Medicaid