Provider Demographics
NPI:1053375113
Name:SIEGEL, DONNA S (RPA-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BARBAROSSA LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1221
Mailing Address - Country:US
Mailing Address - Phone:845-338-3737
Mailing Address - Fax:845-338-3939
Practice Address - Street 1:35 BARBAROSSA LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1221
Practice Address - Country:US
Practice Address - Phone:845-338-3737
Practice Address - Fax:845-338-3939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY347488OtherMVP HEALTH PLANS
NY000494991002OtherBS NORTHEASTERN NY