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General NPI Number Information
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NPI Number | 1629020326
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Entity Type | Individual
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Provider Name | SCOTT ALAN SIEGEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 1535 SLATE CREEK RD
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City | GRUNDY
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State | VA
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Zip | 24614-6974
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Country | US
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Telephone | 276-935-1000
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Fax | 276-935-1302
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Provider Business Mailing Address
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Address Line | 3165 BLACKLOG RD
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City | INEZ
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State | KY
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Zip | 41224-9113
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Country | US
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Telephone | 606-534-3435
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Fax | 606-534-3436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102207660
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04666
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1939
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License Number State | WV
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