Provider Demographics
NPI:1538375274
Name:SIEGEL, MATTHEW (ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6476 BORR AVE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1645
Mailing Address - Country:US
Mailing Address - Phone:614-402-8700
Mailing Address - Fax:
Practice Address - Street 1:4420 REFUGEE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4416
Practice Address - Country:US
Practice Address - Phone:614-839-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-1141173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine