Provider Demographics
NPI:1033221015
Name:SEGURITAN, AYDEN T (PA)
Entity Type:Individual
Prefix:
First Name:AYDEN
Middle Name:T
Last Name:SEGURITAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LELALIE
Other - Middle Name:RASAZO
Other - Last Name:SEGURITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BWPO DBA DEPT OF SURGERY ATTN CENTRAL PROVIDER ENROLLME
Mailing Address - Street 2:111 CYPRESS ST
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-713-2244
Mailing Address - Fax:617-582-1197
Practice Address - Street 1:BRIGHAM & WOMENS HOSPITAL
Practice Address - Street 2:DIVISION OF PLASTIC SURERY 75 FRANCIS ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2098363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical