MEDICARE: SIEGELBAUM, GUNDER & LACEY GASTROENTEROLOGY

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	174400000X	Specialist	MD021958E	PA

General Provider Information

NPI Number	:	1821057605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIEGELBAUM, GUNDER & LACEY GASTROENTEROLOGY

Provider Business Mailing Address
First Line	:	2626 N 3RD ST
Second Line	:	STE.3A
City	:	HARRISBURG
State	:	PA
Zip	:	17110-2044
Country	:	US
Telephone Number	:	717-238-3111
Fax Number	:	717-238-1896

Provider Business Practice Location Address
First Line	:	2626 N 3RD ST
Second Line	:	STE.3A
City	:	HARRISBURG
State	:	PA
Zip	:	17110-2044
Country	:	US
Telephone Number	:	717-238-3111
Fax Number	:	717-238-1896

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DEBORAH JO BAISH
Credential	:
Telephone Number	:	717-238-3111

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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