Healthcare Provider Details

I. General information

NPI: 1437390804
Provider Name (Legal Business Name): PAVAN NATH SEGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 BROSCHART RD
ROCKVILLE MD
20850-3318
US

IV. Provider business mailing address

14901 BROSCHART RD
ROCKVILLE MD
20850-3318
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-4582
  • Fax:
Mailing address:
  • Phone: 301-251-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA106928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036124940
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD78379
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: