Healthcare Provider Details

I. General information

NPI: 1932231396
Provider Name (Legal Business Name): KENNETH M. SEGAL, DPM, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 HOPE STREET
PROVIDENCE RI
02906-2651
US

IV. Provider business mailing address

677 HOPE STREET
PROVIDENCE RI
02906-2651
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-7466
  • Fax: 401-751-3883
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH M SEGAL
Title or Position: PODIATRIST
Credential: DPM
Phone: 401-421-7466