Healthcare Provider Details

I. General information

NPI: 1093715385
Provider Name (Legal Business Name): MARK SEGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PLAZA PROPERTIES BLVD
COLUMBUS OH
43219-1530
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6000
  • Fax: 614-383-6001
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35043494
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35043494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: