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General NPI Number Information
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NPI Number | 1396796520
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Entity Type | Individual
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Provider Name | SUBRAMANYAM SEGU MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 2409 STATE ST
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City | ERIE
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State | PA
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Zip | 16503-1856
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Country | US
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Telephone | 814-452-6320
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Fax | 814-453-7966
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Provider Business Mailing Address
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Address Line | 2409 STATE ST
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City | ERIE
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State | PA
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Zip | 16503-1856
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Country | US
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Telephone | 814-452-6320
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Fax | 814-453-7966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD036091L
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License Number State | PA
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