MEDICARE: DR. FREDRIC TOBIN SEROTA M.D., J.D.

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	208000000X	Pediatrics Physician	MD013478E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588668131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDRIC TOBIN SEROTA M.D., J.D.

Provider Business Mailing Address
First Line	:	602 S BETHLEHEM PIKE
Second Line	:	STE D
City	:	AMBLER
State	:	PA
Zip	:	19002-5800
Country	:	US
Telephone Number	:	215-643-7771
Fax Number	:	215-643-9460

Provider Business Practice Location Address
First Line	:	602 S BETHLEHEM PIKE
Second Line	:	STE D
City	:	AMBLER
State	:	PA
Zip	:	19002-5800
Country	:	US
Telephone Number	:	215-643-7771
Fax Number	:	215-643-9460

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/09/2007

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