Provider Demographics
NPI:1275747636
Name:SEGAL, MANAV (MD)
Entity Type:Individual
Prefix:DR
First Name:MANAV
Middle Name:
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8200 FLOURTOWN AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7969
Mailing Address - Country:US
Mailing Address - Phone:215-247-2292
Mailing Address - Fax:215-247-6885
Practice Address - Street 1:8200 FLOURTOWN AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7969
Practice Address - Country:US
Practice Address - Phone:215-247-2292
Practice Address - Fax:215-247-6885
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426362207K00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD426362OtherSTATE LICENSE
NE23669OtherSTATE LICENSE
BS9716559OtherDEA NUMBER