Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101036792 | VA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101036792 | VA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101036792 | VA |
NPI | 1356316178 |
---|---|
Provider Name | Marc S Siegel |
First Address | Blacksburg, VA 24060 |
Second Address | Blacksburg, VA 24060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 13/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356316178 | (05) | VA |
B08175 | (02) |