Healthcare Provider Details

I. General information

NPI: 1982670949
Provider Name (Legal Business Name): STEVEN KENNETH SEIGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 OLD BRANCH AVE
TEMPLE HILLS MD
20748-2518
US

IV. Provider business mailing address

6104 OLD BRANCH AVE
TEMPLE HILLS MD
20748-2518
US

V. Phone/Fax

Practice location:
  • Phone: 301-702-6167
  • Fax: 301-702-6109
Mailing address:
  • Phone: 301-702-6167
  • Fax: 301-702-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058070
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0066377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: