Healthcare Provider Details

I. General information

NPI: 1871598847
Provider Name (Legal Business Name): PEDRO RAMIRO SEGARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/07/2022
Certification Date: 05/07/2022
Deactivation Date: 11/18/2005
Reactivation Date: 10/18/2006

III. Provider practice location address

595 HAMPTON RD
SOUTHAMPTON NY
11968-3004
US

IV. Provider business mailing address

595 HAMPTON RD
SOUTHAMPTON NY
11968-3004
US

V. Phone/Fax

Practice location:
  • Phone: 631-283-0918
  • Fax: 631-287-4047
Mailing address:
  • Phone: 631-283-0918
  • Fax: 631-702-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number162095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: