MEDICARE: DR. JEROME DAVID SIEGEL MD

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
1	207R00000X	Internal Medicine Physician	52940	MA

General Provider Information

NPI Number	:	1710976709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME DAVID SIEGEL MD

Provider Business Mailing Address
First Line	:	6 COLONIAL DRIVE
Second Line	:	PO BOX 810
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1759
Country	:	US
Telephone Number	:	508-366-3828
Fax Number	:	323-214-0010

Provider Business Practice Location Address
First Line	:	6 COLONIAL DRIVE
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1759
Country	:	US
Telephone Number	:	508-366-3828
Fax Number	:	323-214-0010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	10/16/2015

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