1639184518 NPI number — DR. JUSTIN AARON SIEGAL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639184518 NPI number — DR. JUSTIN AARON SIEGAL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SIEGAL

Provider First Name:

JUSTIN

Provider Middle Name:

AARON

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1639184518

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/08/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

19020 33RD AVE W

Provider Second Line Business Mailing Address:

SUITE 210

Provider Business Mailing Address City Name:

LYNNWOOD

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98036-4746

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

425-563-1500

Provider Business Mailing Address Fax Number:

425-563-1374

Provider First Line Business Practice Location Address:

19020 33RD AVE W

Provider Second Line Business Practice Location Address:

SUITE 210

Provider Business Practice Location Address City Name:

LYNNWOOD

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98036-4746

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

425-563-1500

Provider Business Practice Location Address Fax Number:

425-563-1501

Provider Enumeration Date:

07/29/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085N0700X , with the licence number:  M-12982 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: M-12982 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: MD00042038 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085N0700X , with the licence number: MD00042038 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: US7398683 . This is a "AETNA/USHS PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 234770 . This is a "LNI-KING COUNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 341472 . This is a "LNI OUTSIDE KING COUNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1639184518 . This is a "MONTANA DSHS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 0039587 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 3445SI . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1015172 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".