Provider Demographics
NPI:1508913476
Name:SEGEBARTH, PAUL BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BRADLEY
Last Name:SEGEBARTH
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 1:4601 PARK ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:2001 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1215
Practice Address - Country:US
Practice Address - Phone:704-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39666207X00000X
NC2007-01152207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9932128OtherAETNA
TN1507091Medicaid
TN4194925OtherBLUECROSS BLUESHIELD
TN7100083360OtherKY. MEDICAID
TN1507089Medicaid
SCN0115AMedicaid
TNP00762681OtherRAILROAD MEDICARE
TN30019371Medicare PIN
SCN0115AMedicaid
TN3001937Medicare PIN
NC2073804AMedicare PIN
TN1507089Medicaid
TN1507091Medicaid
NC0397730028Medicare NSC