Healthcare Provider Details

I. General information

NPI: 1578728903
Provider Name (Legal Business Name): JOSE SERRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 DEMOCRACY BLVD STE 6022
BETHESDA MD
20817-1129
US

IV. Provider business mailing address

6707 DEMOCRACY BLVD RM 6022
BETHESDA MD
20817-1129
US

V. Phone/Fax

Practice location:
  • Phone: 204-593-4271
  • Fax:
Mailing address:
  • Phone: 240-593-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21421
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number21421
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: