Individual provider Active NPI

Roger J. Segalla Jr., PH.D.

  • Psychologist
  • Bethesda, MD
National Provider Identifier
1285783779
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3374 Issued in MD
Practice address
4809 Saint Elmo Ave
Bethesda, MD 20814-3009
Phone
(301) 652-1707
Fax
(301) 652-1654
NPI assigned
Jan 10, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3374 MD Primary

Addresses

Primary practice location

4809 Saint Elmo Ave
Bethesda, MD 20814-3009

Mailing address

4809 Saint Elmo Ave
Bethesda, MD 20814-3009
Phone (301) 652-1707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3374MDMDPsychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285783779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4809 SAINT ELMO AVE",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208143009",
            "telephone_number": "301-652-1707",
            "fax_number": "301-652-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4809 SAINT ELMO AVE",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208143009",
            "telephone_number": "301-652-1707",
            "fax_number": "301-652-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGALLA",
        "first_name": "ROGER",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "3374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.