Healthcare Provider Details

I. General information

NPI: 1386687507
Provider Name (Legal Business Name): RICHARD ALDO SERRAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA BOSTON HEALTHCARE SYSTEM 150 SOUTH HUNTINGTON AVE, 111-ID
JAMAICA PLAIN MA
02130
US

IV. Provider business mailing address

150 S HUNTINGTON AVE 111-ID
JAMAICA PLAIN MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4669
  • Fax: 857-364-4564
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number205822
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number205822
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number205822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: