Healthcare Provider Details

I. General information

NPI: 1851093686
Provider Name (Legal Business Name): MIGUEL SERRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 10/12/2026
Certification Date: 10/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TOZER RD STE 202
BEVERLY MA
01915-5514
US

IV. Provider business mailing address

PO BOX 24532
NEW YORK NY
10087-4532
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-7727
  • Fax:
Mailing address:
  • Phone: 781-744-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1028116
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: