Provider Demographics
NPI:1114030954
Name:SIEGRIST, MARIANNE LAND (DO)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:LAND
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-378-5010
Mailing Address - Fax:804-378-3264
Practice Address - Street 1:10201 KRAUSE ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832
Practice Address - Country:US
Practice Address - Phone:804-748-6229
Practice Address - Fax:804-748-5909
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA318871OtherANTHEM BS
G44266Medicare UPIN