Provider Demographics
NPI:1174661847
Name:SEGALOVE, HARVEY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:PAUL
Last Name:SEGALOVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15200 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1013
Mailing Address - Country:US
Mailing Address - Phone:510-352-9690
Mailing Address - Fax:510-352-9008
Practice Address - Street 1:15200 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1013
Practice Address - Country:US
Practice Address - Phone:510-352-9690
Practice Address - Fax:510-352-9008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0481102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA850937Medicare UPIN
CA00G554460Medicare ID - Type Unspecified