Healthcare Provider Details

I. General information

NPI: 1841819653
Provider Name (Legal Business Name): MOHANED SALIM SERDAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 QUEEN ST STE 103
SOUTHINGTON CT
06489-1801
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-628-0703
  • Fax: 860-276-1940
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number83448
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: