Provider Demographics
NPI:1558471292
Name:SEGAL, SHIMON (MD)
Entity Type:Individual
Prefix:
First Name:SHIMON
Middle Name:
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 1:99 POND AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7117
Mailing Address - Country:US
Mailing Address - Phone:617-264-7227
Mailing Address - Fax:617-264-7227
Practice Address - Street 1:70 WALNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-2137
Practice Address - Country:US
Practice Address - Phone:617-340-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82166207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB320AOtherMEDICARE OF FL
MA3158314Medicaid
MAA21347Medicare PIN
MA3158314Medicaid