MEDICARE: ROBERT MICHAEL SERRA MD

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	207RN0300X	Nephrology Physician	5961	RI

General Provider Information

NPI Number	:	1740394030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MICHAEL SERRA MD

Provider Business Mailing Address
First Line	:	17 WELLS ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2923
Country	:	US
Telephone Number	:	401-596-3313
Fax Number	:	401-596-2650

Provider Business Practice Location Address
First Line	:	17 WELLS ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2923
Country	:	US
Telephone Number	:	401-596-3313
Fax Number	:	401-596-2650

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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