Provider Demographics
NPI:1437227378
Name:SEGRE, TIFFANY P (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:P
Last Name:SEGRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038
Practice Address - Country:US
Practice Address - Phone:207-839-5225
Practice Address - Fax:207-839-7850
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME017198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432622599Medicaid
NH30208162Medicaid
MEP00420626Medicare PIN
MEP00930078Medicare PIN
NH30208162Medicaid
ME000169601Medicare PIN