Basic Information
| Provider Information | |||||||||
| NPI: | 1275747636 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGAL | ||||||||
| FirstName: | MANAV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 FLOURTOWN AVENUE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | WYNDMOOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190387969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152472292 | ||||||||
| FaxNumber: | 2152476885 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 FLOURTOWN AVENUE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | WYNDMOOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190387969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152472292 | ||||||||
| FaxNumber: | 2152476885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 23669 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0201X | MD426362 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 23669 | 01 | NE | STATE LICENSE | OTHER | MD426362 | 01 | PA | STATE LICENSE | OTHER | BS9716559 | 01 | DEA NUMBER | OTHER |