Provider Demographics
NPI:1255437182
Name:SIEGERT, ELISABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:
Last Name:SIEGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:309 BRIDGEBORO RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1419
Practice Address - Country:US
Practice Address - Phone:856-439-2069
Practice Address - Fax:856-439-2078
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-047121-L207R00000X, 207RG0300X
NJMA52232207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5247101Medicaid
NJ6023318OtherCIGNA HEALTH PLAN
NJ1269659OtherUNITED HEALTH PLAN
NJ1055461OtherHORIZON NJ HEALTH
NJ13607OtherUNIVERSITY HEALTH PLAN
NJ84129OtherAMERICAID
NJF08313OtherHEALTHNET, INC
NJP468068OtherOXFORD HALTH PLAN
NJ0563624000OtherAMERIHEALTH HMO
NJ510969OtherAETNA US HEALTHCARE
NJ84129OtherAMERIGROUP
NJ13607OtherUNIVERSITY HEALTH PLAN
NJF08313OtherHEALTHNET, INC