Healthcare Provider Details

I. General information

NPI: 1326024019
Provider Name (Legal Business Name): GARY K SEGALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN DEPT OF PATHOLOGY
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

8166 MARKET ST SUITE D
YOUNGSTOWN OH
44512-6262
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-3767
  • Fax: 330-884-3790
Mailing address:
  • Phone: 330-953-3242
  • Fax: 330-953-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35-06-3664-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: