Provider Demographics
NPI:1336169044
Name:SIEGEL, CHRISTOPHER T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
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 1:6770 MAYFIELD RD. SUITE 421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6770 MAYFIELD RD. SUITE 421
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-1716
Practice Address - Country:US
Practice Address - Phone:440-449-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076790204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2130732OtherBCMH
OHP00372966OtherRAILROAD MEDICARE
OH364012OtherWELLCARE
OH000000221082OtherUNISON
OH2130732Medicaid
OH738100OtherBUCKEYE
7461008OtherAETNA
OHP00235804OtherRAILROAD MEDICARE
000000503726OtherANTHEM
7461008OtherAETNA
OH2130732Medicaid
SI0887013Medicare PIN