Provider Demographics
NPI:1548408362
Name:SEVAG, GAYANE (PA-C)
Entity type:Individual
Prefix:
First Name:GAYANE
Middle Name:
Last Name:SEVAG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GAYANE
Other - Middle Name:
Other - Last Name:KASPAROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-1000
Mailing Address - Fax:484-476-9000
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-1000
Practice Address - Fax:484-476-9000
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053647363AS0400X
DEC5-0000931363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083892OtherNCCPA