Provider Demographics
NPI:1659453223
Name:SEGAL, ALAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SCOTT
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 1:1600 CONGRESS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2143
Mailing Address - Country:US
Mailing Address - Phone:207-774-5222
Mailing Address - Fax:
Practice Address - Street 1:1600 CONGRESS ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2143
Practice Address - Country:US
Practice Address - Phone:207-774-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25413207RN0300X
VT042-0009311207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1383Medicaid
NY01666646Medicaid
VTF42406Medicare UPIN
VTSEVN1383Medicare ID - Type Unspecified