Provider Demographics
NPI:1356614002
Name:ANDREW SEGAL, MD, PA
Entity type:Organization
Organization Name:ANDREW SEGAL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-261-7300
Mailing Address - Street 1:801 ROAD TO SIX FLAGS W
Mailing Address - Street 2:123
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2616
Mailing Address - Country:US
Mailing Address - Phone:817-261-7300
Mailing Address - Fax:817-861-2004
Practice Address - Street 1:801 ROAD TO SIX FLAGS W
Practice Address - Street 2:123
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2616
Practice Address - Country:US
Practice Address - Phone:817-261-7300
Practice Address - Fax:817-861-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty