Provider Demographics
NPI:1619931870
Name:SIEGEL, TIMOTHY R (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:SIEGEL
Suffix:
Gender:M
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:603-308-1472
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33592208600000X
NH15327208600000X, 2086H0002X
VA0101257693208600000X, 2086H0002X
ORMD1838912086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019444Medicaid
NH32000782Medicaid
NH002323701OtherMEDICARE PTAN
NY01929280Medicaid
NH3073841Medicaid
NHAA224057OtherHARVARD PILGRIM
VT1019444Medicaid
NYC06639Medicare UPIN