Provider Demographics
NPI:1235287483
Name:LEONARD-SEGAL, ANDREA
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LEONARD-SEGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 LAUREL LEAF DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1763
Mailing Address - Country:US
Mailing Address - Phone:301-983-3126
Mailing Address - Fax:
Practice Address - Street 1:908 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2346
Practice Address - Country:US
Practice Address - Phone:202-833-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD11187207RR0500X
MDD0029278207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76248Medicare UPIN