Provider Demographics
NPI:1962445536
Name:SIEGEL, NATHAN A (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
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:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12096207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1962445536OtherNPI
MA2121034Medicaid
RI9/26/2006OtherNHPRI
RI7058670Medicaid
RI413313OtherBLUECHIP
RI939025129OtherRI MEDICARE GROUP NUMBER
MA12/29/2008OtherTUFTS HEALTH PLAN
P00325140OtherRAILROAD MEDICARE
RI04/15/2009OtherUNITED HEALTHCARE
RI413313OtherBLUECHIP
RI04/15/2009OtherUNITED HEALTHCARE