Healthcare Provider Details

I. General information

NPI: 1134153034
Provider Name (Legal Business Name): NEIL M SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S PACA ST
BALTIMORE MD
21201-1771
US

IV. Provider business mailing address

PO BOX 64888
BALTIMORE MD
21264-4888
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1800
  • Fax: 410-365-1973
Mailing address:
  • Phone: 800-889-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD43574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: