Basic Information
Provider Information | |||||||||
NPI: | 1174698419 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SIEGART | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 380 LAFAYETTE RD | ||||||||
Address2: |   | ||||||||
City: | HAMPTON | ||||||||
State: | NH | ||||||||
PostalCode: | 038422222 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6039260088 | ||||||||
FaxNumber: | 6039262853 | ||||||||
Practice Location | |||||||||
Address1: | 5 ALUMNI DR | ||||||||
Address2: |   | ||||||||
City: | EXETER | ||||||||
State: | NH | ||||||||
PostalCode: | 038332128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035806793 | ||||||||
FaxNumber: | 6035807006 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/21/2006 | ||||||||
LastUpdateDate: | 05/04/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9436 | NH | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 000000042890 | 01 |   | BMC HEALTHNET PLAN | OTHER | 0162108 | 05 | MA |   | MEDICAID | 930114660 | 01 |   | RAILROAD MEDICARE | OTHER | AA17419 | 01 |   | HARVARD PILGRIM | OTHER | 30221919 | 05 | NH |   | MEDICAID | 0401088Y0NH01 | 01 | NH | ANTHEM | OTHER | 299790099 | 05 | NH |   | MEDICAID |