Provider Demographics
NPI:1871598847
Name:SEGARRA, PEDRO RAMIRO (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:RAMIRO
Last Name:SEGARRA
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 1:595 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3004
Mailing Address - Country:US
Mailing Address - Phone:631-283-0918
Mailing Address - Fax:631-702-2106
Practice Address - Street 1:595 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3004
Practice Address - Country:US
Practice Address - Phone:631-283-0918
Practice Address - Fax:631-287-4047
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-05-07
Deactivation Date:2005-11-18
Deactivation Code:
Reactivation Date:2006-10-18
Provider Licenses
StateLicense IDTaxonomies
NY162095207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0042944OtherGHI PPO#
NY4235497OtherAETNA PPO#
NY742C31OtherEMPIRE BC/BS# (NY)
NY97D893OtherEMPIRE BCBS# (JACKSON HEIGHTS)
NY2125953OtherAETNA HMO#
NY0C1483OtherHEALTHNET#
NYDP530OtherOXFORD#
NY160019050OtherRAILROAD MEDICARE#
NY162095OtherHIP#
NY07133GMedicare PIN
NY97D891Medicare PIN
NY2125953OtherAETNA HMO#
NYA65195Medicare UPIN