Provider Demographics
NPI:1992730212
Name:SEGAL, SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 MAIN ST. S, C/O NVRA
Mailing Address - Street 2:UNION SQUARE BLDG #1
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-7999
Mailing Address - Fax:203-264-7477
Practice Address - Street 1:385 MAIN ST S
Practice Address - Street 2:UNION SQUARE BLDG#2
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4240
Practice Address - Country:US
Practice Address - Phone:203-264-7999
Practice Address - Fax:203-264-7477
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0408512085R0204X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001408518Medicaid
CT940000010OtherPDI
CT940000006Medicare ID - Type UnspecifiedNVCI
CT940000005Medicare ID - Type UnspecifiedHIA
CT940000009Medicare ID - Type UnspecifiedDIS
H03034Medicare UPIN
CT940000008Medicare ID - Type UnspecifiedDIA
CT940000011Medicare ID - Type UnspecifiedMRI
CT940000012Medicare ID - Type UnspecifiedNDI
CT940000010Medicare ID - Type UnspecifiedPDI