Provider Demographics
NPI:1790754265
Name:SEGRE, GINO VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:GINO
Middle Name:VICTOR
Last Name:SEGRE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST WEL 5
Practice Address - Street 2:ENDOCRINE ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3966
Practice Address - Fax:617-726-7543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA32828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM07841OtherBCBS MA
MA2007517Medicaid
MA724174OtherTUFTS HEALTH PLAN
MA2007517Medicaid
D83004Medicare UPIN