Provider Demographics
NPI:1245399237
Name:SEVIGNY, GINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:SEVIGNY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:305 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8181
Mailing Address - Country:US
Mailing Address - Phone:386-615-1771
Mailing Address - Fax:386-615-1545
Practice Address - Street 1:305 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8181
Practice Address - Country:US
Practice Address - Phone:386-615-1771
Practice Address - Fax:386-615-1545
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME69303207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013466900Medicaid
FLG67856Medicare UPIN
FL68883XMedicare PIN
FL013466900Medicaid