Healthcare Provider Details

I. General information

NPI: 1538985445
Provider Name (Legal Business Name): MARY THERESA SIEGFRIED CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY THERESA HARRINGTON

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 540-931-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024198737
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: