Healthcare Provider Details

I. General information

NPI: 1679796726
Provider Name (Legal Business Name): BRIAN MICHAEL SIEGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WINDSOR RD
PIKESVILLE MD
21208-4762
US

IV. Provider business mailing address

205 E JOPPA RD SUITE 103
TOWSON MD
21286-3260
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-6484
  • Fax:
Mailing address:
  • Phone: 410-296-3448
  • Fax: 410-296-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number307185
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberD30195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: