Individual
BRAD THOMAS SIEGMUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9274
(804) 862-5010
Mailing address
PO BOX 36559, NORTH CHESTERFIELD, VA 23235-8011
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101034642
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932170909
—
VA
01
—
P01155111
RAILROAD MEDICARE
—
Enumeration date
01/30/2006
Last updated
05/13/2013
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