Provider Demographics
NPI:1952509390
Name:SIEGRIST, JEREMY PETER (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:PETER
Last Name:SIEGRIST
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 1:1800 CAMELOT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2440
Mailing Address - Country:US
Mailing Address - Phone:757-252-9600
Mailing Address - Fax:757-351-2905
Practice Address - Street 1:1800 CAMELOT DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2440
Practice Address - Country:US
Practice Address - Phone:757-252-9600
Practice Address - Fax:757-351-2905
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247001172V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty