Provider Demographics
NPI:1336195866
Name:SEGAL, HAROLD D (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:D
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 1:140 CASA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1804
Mailing Address - Country:US
Mailing Address - Phone:805-543-4319
Mailing Address - Fax:805-543-0446
Practice Address - Street 1:140 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1804
Practice Address - Country:US
Practice Address - Phone:805-543-4319
Practice Address - Fax:805-543-0446
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3505983OtherFEDERAL TAX ID
CAA32286OtherSTATE LICENSE
CAC35397Medicare UPIN