Healthcare Provider Details

I. General information

NPI: 1356316178
Provider Name (Legal Business Name): MARC S SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROFESSIONAL PARK DR STE 7
BLACKSBURG VA
24060
US

IV. Provider business mailing address

120 PROFESSIONAL PARK DR STE 7
BLACKSBURG VA
24060
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-3601
  • Fax: 540-552-7585
Mailing address:
  • Phone: 540-552-3601
  • Fax: 540-552-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101036792
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0101036792
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101036792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: