Provider Demographics
NPI:1730142969
Name:SIEGEL, MICHAEL BART (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BART
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 1:15204 OMEGA DR STE 310
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4816
Mailing Address - Country:US
Mailing Address - Phone:240-361-9000
Mailing Address - Fax:240-361-9001
Practice Address - Street 1:15204 OMEGA DR STE 310
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4816
Practice Address - Country:US
Practice Address - Phone:240-361-9000
Practice Address - Fax:240-361-9001
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041437207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4271330OtherAETNA
MDMAMSIOther228407
DCB0480001OtherBCBS OF DC
MD8789OtherBCBS OF MD
MD496957OtherNCPPO
MD496957OtherNCPPO
MDE91506Medicare UPIN