Healthcare Provider Details

I. General information

NPI: 1194014902
Provider Name (Legal Business Name): ALLISON J SIEGEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N. WASHINGTON ST. STE. 100
FALLS CHURCH VA
22046
US

IV. Provider business mailing address

407 N. WASHINGTON ST. STE. 100
FALLS CHURCH VA
22046
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-5919
  • Fax: 703-241-1863
Mailing address:
  • Phone: 703-237-5919
  • Fax: 703-241-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101256036
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: