Healthcare Provider Details

I. General information

NPI: 1205160736
Provider Name (Legal Business Name): JEROME SEGAL, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 BESTGATE RD SUITE 211
ANNAPOLIS MD
21401-3091
US

IV. Provider business mailing address

888 BESTGATE RD SUITE 211
ANNAPOLIS MD
21401-3091
US

V. Phone/Fax

Practice location:
  • Phone: 410-897-0822
  • Fax: 443-949-8603
Mailing address:
  • Phone: 410-897-0822
  • Fax: 443-949-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0056089
License Number StateMD

VIII. Authorized Official

Name: DR. JEROME SEGAL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 240-994-9458