Provider Demographics
NPI:1619127453
Name:SEGAL, MARTHA FOX (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:FOX
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:L
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3653
Mailing Address - Country:US
Mailing Address - Phone:508-862-5504
Mailing Address - Fax:508-790-3304
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3653
Practice Address - Country:US
Practice Address - Phone:508-862-5504
Practice Address - Fax:508-790-3304
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2338522084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400254678Medicare PIN