MEDICARE: DR. AUDRA ROCHELLE SIEGEL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	65 006034	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1235164997	OTHER	NPI GROUP ID
2	AS00573K10	OTHER	BLUE CROSS BLUE SHIELD PIN/IDENTIFIER
3	10111279	OTHER	CDPHP PIN/IDENTIFIER
4	200053170	OTHER	MVP HEALTHCARE GROUP ID
5	65 006034	OTHER	NYS PROFESSIONAL LICENSE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4148374	OTHER	MVP HEALTHCARE PIN

General Provider Information

NPI Number	:	1538163290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDRA ROCHELLE SIEGEL DPM

Provider Business Mailing Address
First Line	:	243 NORTH RD STE 304
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12601-1173
Country	:	US
Telephone Number	:	845-451-7251
Fax Number	:	845-471-7372

Provider Business Practice Location Address
First Line	:	696 DUTCHESS TPKE STE M
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-6429
Country	:	US
Telephone Number	:	845-464-0630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/31/2022

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Directions to “ DR. AUDRA ROCHELLE SIEGEL DPM” Practice Location

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