Provider Demographics
NPI:1801887427
Name:SEGAL, ELIZABETH O (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 THOMAS JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5156
Mailing Address - Country:US
Mailing Address - Phone:301-695-6900
Mailing Address - Fax:301-695-3420
Practice Address - Street 1:195 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5156
Practice Address - Country:US
Practice Address - Phone:301-695-6900
Practice Address - Fax:301-695-3420
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0030282207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD325661800Medicaid
MD7439Medicare ID - Type Unspecified
MD325661800Medicaid
MD0789890001Medicare NSC
0180188742Medicare NSC