Provider Demographics
NPI:1407855190
Name:SEGALL, ERROL (MD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:
Last Name:SEGALL
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 1:8500 EXECUTIVE PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2225
Mailing Address - Country:US
Mailing Address - Phone:703-698-5220
Mailing Address - Fax:703-573-2351
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:703-698-5220
Practice Address - Fax:703-573-2351
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010316622084P0800X
MDD00426792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA513455OtherNCPPO
VA032028OtherVALUE OPTIONS
520045OtherMAMSI
MD403200400Medicaid
4137282OtherAETNA
DC0001OtherCAREFIRST NCA
VA110142-000OtherMAGELLAN
VA153479OtherANTHEM
VA153479OtherANTHEM
4137282OtherAETNA
VA260003109Medicare PIN