Provider Demographics
NPI:1821086323
Name:SEGAL, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
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 1:1065 NE 125TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:1065 NE 125TH ST STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5832
Practice Address - Country:US
Practice Address - Phone:305-891-0050
Practice Address - Fax:305-891-0497
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME546222084A0401X, 2084P0804X, 2084P0800X
CODR.00366192084A0401X, 2084P0800X, 2084P0804X
ND198282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23001071Medicaid
FL370090900Medicaid
CO23001071Medicaid
FL260010072OtherMEDICARE RAILROAD NUMBER
COCOA105550Medicare PIN
FLE59509Medicare UPIN
MD412527400OtherMARYLAND MEDICAID NUMBER