Provider Demographics
NPI:1912973637
Name:SIEGRIST, STEPHEN K (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:SIEGRIST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 KRAUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6575
Mailing Address - Country:US
Mailing Address - Phone:804-748-6229
Mailing Address - Fax:804-748-5909
Practice Address - Street 1:10201 KRAUSE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6575
Practice Address - Country:US
Practice Address - Phone:804-748-6229
Practice Address - Fax:804-748-5909
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5637970Medicaid
VA010001226 - C03895Medicare ID - Type Unspecified
VA5637970Medicaid