Healthcare Provider Details

I. General information

NPI: 1922080126
Provider Name (Legal Business Name): MARIASTELLA SERRANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WISCONSIN AVE NW STE 400
WASHINGTON DC
20016-2100
US

IV. Provider business mailing address

4200 WISCONSIN AVE NW STE 400
WASHINGTON DC
20016-2100
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-3558
  • Fax: 877-680-5504
Mailing address:
  • Phone: 202-243-3558
  • Fax: 877-680-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD045865
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: