Healthcare Provider Details

I. General information

NPI: 1578562617
Provider Name (Legal Business Name): EVAN L SIEGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14995 SHADY GROVE RD STE 250
ROCKVILLE MD
20850-8726
US

IV. Provider business mailing address

2730 UNIVERSITY BLVD W SUITE 310
SILVER SPRING MD
20902-1905
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-7600
  • Fax: 301-942-3521
Mailing address:
  • Phone: 301-942-7600
  • Fax: 301-942-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0038512
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: