Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 226444 | MA |
Y | 207R00000X | Internist | 226444 | MA |
Y | 111NI0900X | Internist | 226444 | MA |
NPI | 1003892001 |
---|---|
Provider Name | Dr. Lydia C Siegel |
First Address | Boston, MA 02445 |
Second Address | Jamaica Plain, MA 02130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 12/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2119064 | (05) | MA |
I65503 | (02) |