Basic Information
| Provider Information | |||||||||
| NPI: | 1679769046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGAL | ||||||||
| FirstName: | LORISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 289 COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050899000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026746711 | ||||||||
| FaxNumber: | 8026747155 | ||||||||
| Practice Location | |||||||||
| Address1: | 32 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050911122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024573030 | ||||||||
| FaxNumber: | 8024572157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0420011656 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.