Provider Demographics
NPI:1780816421
Name:SEGEV, GILEAD
Entity Type:Individual
Prefix:MR
First Name:GILEAD
Middle Name:
Last Name:SEGEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3853
Mailing Address - Country:US
Mailing Address - Phone:703-547-9357
Mailing Address - Fax:703-942-6067
Practice Address - Street 1:8230 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 550
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3853
Practice Address - Country:US
Practice Address - Phone:703-547-9357
Practice Address - Fax:703-942-6067
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235074207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology