Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 23669 | NE |
N | 111NI0900X | Internist | 23669 | NE |
Y | 207RA0201X | Internist - Allergy & Immunology | MD426362 | PA |
NPI | 1275747636 |
---|---|
Provider Name | Dr. Manav Segal |
First Address | Wyndmoor, PA 19038-7969 |
Second Address | Wyndmoor, PA 19038-7969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23669 | STATE LICENSE (01) | NE |
BS9716559 | DEA NUMBER (01) | |
MD426362 | STATE LICENSE (01) | PA |