Provider Demographics
NPI:1174607030
Name:DAVID SIEGENBERG,MD,PC
Entity type:Organization
Organization Name:DAVID SIEGENBERG,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-944-1166
Mailing Address - Street 1:30 NEWCROSSING RD
Mailing Address - Street 2:SUITE # 310
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3254
Mailing Address - Country:US
Mailing Address - Phone:781-944-1166
Mailing Address - Fax:781-944-1168
Practice Address - Street 1:30 NEWCROSSING RD
Practice Address - Street 2:SUITE # 310
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3254
Practice Address - Country:US
Practice Address - Phone:781-944-1166
Practice Address - Fax:781-944-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADF7238OtherRAIL ROAD MEDICARE
MADF7238OtherRAIL ROAD MEDICARE