Healthcare Provider Details

I. General information

NPI: 1326244369
Provider Name (Legal Business Name): EDWARD N SIGUEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CROOKED CREEK DR
ROCKVILLE MD
20850-5773
US

IV. Provider business mailing address

PO BOX 10187
GAITHERSBURG MD
20898-0187
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-0836
  • Fax:
Mailing address:
  • Phone: 301-869-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberD50518
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: