Provider Demographics
NPI:1134102502
Name:SEGALCHIK, ALLA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:SEGALCHIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:KAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001385363A00000X
MN10194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000342192OtherANTHEM
OHP00213551OtherRAILROAD MEDICARE
MN917638000Medicaid
OH000000342192OtherANTHEM
MN970002778Medicare PIN
P18659Medicare UPIN