Provider Demographics
NPI:1437232451
Name:SEGALL, MARK MELVYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MELVYN
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 1:15195 NATIONAL AVE
Mailing Address - Street 2:STE. #202
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2631
Mailing Address - Country:US
Mailing Address - Phone:408-358-3500
Mailing Address - Fax:408-358-3608
Practice Address - Street 1:15195 NATIONAL AVE
Practice Address - Street 2:STE. #202
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2631
Practice Address - Country:US
Practice Address - Phone:408-358-3500
Practice Address - Fax:408-358-3608
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG024951208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0954018Medicaid
CA0954018Medicaid
CA00G249511Medicare PIN