Provider Demographics
NPI:1437390804
Name:SEGAL, PAVAN NATH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:NATH
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 1:14901 BROSCHART RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3318
Mailing Address - Country:US
Mailing Address - Phone:301-251-4582
Mailing Address - Fax:
Practice Address - Street 1:14901 BROSCHART RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3318
Practice Address - Country:US
Practice Address - Phone:301-251-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1069282084P0800X
IL0361249402084P0804X
MDD783792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry