1538228549 NPI number — DR. CHRIS H SERLO D.P.M.

Table of content: DR. CHRIS H SERLO D.P.M. (NPI 1538228549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538228549 NPI number — DR. CHRIS H SERLO D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERLO
Provider First Name:
CHRIS
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538228549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15201 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-921-0009
Provider Business Mailing Address Fax Number:
301-921-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15201 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-921-0009
Provider Business Practice Location Address Fax Number:
301-921-0019
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  00638 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: T289 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 34050-8700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4243656 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2300969 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52-1346837 . This is a "TAX ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21651 . This is a "MDIPA OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6387 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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