Provider Demographics
NPI:1730529306
Name:SEGURITAN, RICHARD ERIC (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERIC
Last Name:SEGURITAN
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 1:125 METRO CENTER BOULEVARD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1768
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BOULEVARD
Practice Address - Street 2:SUITE 2000
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1768
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYFR0435669392207R00000X
NY08274169390200000X
RIMD161592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty