Provider Demographics
NPI:1881660991
Name:SEGAL, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
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 1:11544 DOWNEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4955
Mailing Address - Country:US
Mailing Address - Phone:562-414-9846
Mailing Address - Fax:562-923-7209
Practice Address - Street 1:11544 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4955
Practice Address - Country:US
Practice Address - Phone:562-414-9846
Practice Address - Fax:562-923-7209
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99814207RC0000X
NJ25MA07993800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0091651Medicaid
NJ0091651Medicaid
CAW7294Medicare PIN