Provider Demographics
NPI:1265446157
Name:SEGAL, ELLIOTT GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:GERALD
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126B SEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5327
Mailing Address - Country:US
Mailing Address - Phone:617-734-8231
Mailing Address - Fax:
Practice Address - Street 1:126B SEWALL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5327
Practice Address - Country:US
Practice Address - Phone:617-734-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA289022084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine