Healthcare Provider Details

I. General information

NPI: 1124066154
Provider Name (Legal Business Name): ANGEL A FERNANDEZ SEGURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/21/2022
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON PL STE 204
BEDFORD NH
03110-6750
US

IV. Provider business mailing address

9 WASHINGTON PL STE 204
BEDFORD NH
03110-6750
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4450
  • Fax: 603-606-3049
Mailing address:
  • Phone: 603-624-4450
  • Fax: 603-606-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD16614
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME129060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: