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NPI Code Detail

MEDICARE: GARY EDWARD SIEGEL M.D.

MEDICARE: GARY EDWARD SIEGEL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician036289GA
2207LP2900XPain Medicine (Anesthesiology) Physician036289GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3050048443OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548241151
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY EDWARD SIEGEL M.D.
Provider Business Mailing Address
First Line : PO BOX 3559
Second Line :
City : SUWANEE
State : GA
Zip : 30024-0993
Country : US
Telephone Number : 770-979-9996
Fax Number : 770-979-1202
Provider Business Practice Location Address
First Line : 1700 MEDICAL WAY
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2195
Country : US
Telephone Number : 770-979-9996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 06/28/2010

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