Healthcare Provider Details

I. General information

NPI: 1194864819
Provider Name (Legal Business Name): ERIC SEREJSKI DIPL. AC & CH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W PATRICK STREET
FREDERICK MD
21701-5516
US

IV. Provider business mailing address

7720 WISCONSIN AVENUE SUITE 217
BETHESDA MD
20814-3529
US

V. Phone/Fax

Practice location:
  • Phone: 240-688-3431
  • Fax: 240-846-1533
Mailing address:
  • Phone: 301-913-0345
  • Fax: 240-846-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU00485
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: