Provider Demographics
NPI:1013981380
Name:SIEGEL, MARK IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:IRA
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:60 GRAMERCY PARK N
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5423
Mailing Address - Country:US
Mailing Address - Phone:212-254-6387
Mailing Address - Fax:212-674-1933
Practice Address - Street 1:60 GRAMERCY PARK N
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5423
Practice Address - Country:US
Practice Address - Phone:212-254-6387
Practice Address - Fax:212-674-1933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY131654207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715857Medicaid
NY00715857Medicaid
69A551Medicare ID - Type Unspecified