Healthcare Provider Details

I. General information

NPI: 1194780478
Provider Name (Legal Business Name): ROBERT JAMES SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD DEPARTMENT OF PATHOLOGY
LAWRENCEVILLE GA
30046-7694
US

IV. Provider business mailing address

PO BOX 1686
INDIANAPOLIS IN
46206-1686
US

V. Phone/Fax

Practice location:
  • Phone: 678-442-4321
  • Fax:
Mailing address:
  • Phone: 800-346-1181
  • Fax: 706-232-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number023679
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number023679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: