Healthcare Provider Details

I. General information

NPI: 1376916163
Provider Name (Legal Business Name): ALISHA SEGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 EMMORTON RD STE 201
BEL AIR MD
21015-6180
US

IV. Provider business mailing address

7055 SAMUEL MORSE DR STE 200
COLUMBIA MD
21046-3441
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 410-910-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR191575
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: