Healthcare Provider Details

I. General information

NPI: 1851459093
Provider Name (Legal Business Name): CAROLYN LIANE SIEGAL D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 03/19/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 PROVIDENCE HIGHWAY
NORWOOD MA
02062
US

IV. Provider business mailing address

1177 PROVIDENCE HIGHWAY
NORWOOD MA
02062
US

V. Phone/Fax

Practice location:
  • Phone: 781-278-5635
  • Fax: 781-440-7585
Mailing address:
  • Phone: 781-278-5635
  • Fax: 781-440-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4248
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2308
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: