Provider Demographics
NPI:1205160736
Name:JEROME SEGAL, M.D., P.C.
Entity type:Organization
Organization Name:JEROME SEGAL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-994-9458
Mailing Address - Street 1:888 BESTGATE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3091
Mailing Address - Country:US
Mailing Address - Phone:410-897-0822
Mailing Address - Fax:443-949-8603
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-897-0822
Practice Address - Fax:443-949-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056089207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty