MEDICARE: VIPAPORN SERIBURY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C0003544	MD

General Provider Information

NPI Number	:	1174791248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIPAPORN SERIBURY PA-C

Provider Business Mailing Address
First Line	:	1500 FOREST GLEN RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1484
Country	:	US
Telephone Number	:	410-960-9439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 FOREST GLEN RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1484
Country	:	US
Telephone Number	:	301-754-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	11/13/2025

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Directions to “ VIPAPORN SERIBURY PA-C” Practice Location

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