Healthcare Provider Details

I. General information

NPI: 1861405367
Provider Name (Legal Business Name): JOHN PETER SERLEMITSOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 PENDERBROOKE DR
CROWNSVILLE MD
21032-1918
US

IV. Provider business mailing address

2033 PENDERBROOKE DR
CROWNSVILLE MD
21032-1918
US

V. Phone/Fax

Practice location:
  • Phone: 443-790-2689
  • Fax: 443-292-8296
Mailing address:
  • Phone: 443-790-2689
  • Fax: 443-292-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0032654
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: