Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 034745 | NY |
Y | 1223P0700X | Prosthodontist | DS022015L | PA |
NPI | 1083749675 |
---|---|
Provider Name | Dr. Aaron G Segal |
First Address | Philadelphia, PA 19140-5007 |
Second Address | Philadelphia, PA 19140-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 02/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DS022015L | LICENSE (01) | PA |