Provider Demographics
NPI:1891719068
Name:SEGAL, DAVID S (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:SEGAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ISLAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3507
Mailing Address - Country:US
Mailing Address - Phone:603-354-6700
Mailing Address - Fax:
Practice Address - Street 1:69 ISLAND ST STE C
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3507
Practice Address - Country:US
Practice Address - Phone:603-354-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003950Medicaid
NHAP0717Medicare PIN
S47275Medicare UPIN