Healthcare Provider Details

I. General information

NPI: 1457212896
Provider Name (Legal Business Name): STEPHEN GARY SIEGLEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 MID ATLANTIC PKWY STE 1
MARTINSBURG WV
25404-7468
US

IV. Provider business mailing address

707 MORGAN ST
MARTINSBURG WV
25401-1801
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3997
  • Fax: 304-471-2488
Mailing address:
  • Phone: 681-534-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: