Provider Demographics
NPI:1821013764
Name:SEGAL, OLGA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3055
Mailing Address - Country:US
Mailing Address - Phone:707-279-2932
Mailing Address - Fax:707-994-7096
Practice Address - Street 1:3455 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451-8227
Practice Address - Country:US
Practice Address - Phone:707-279-2932
Practice Address - Fax:707-994-7096
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA857742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A857740OtherPIN NUMBER
CAI51752Medicare UPIN