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NPI Code Detail

MEDICARE: DR. JOSE A. SERRANO-MARTINEZ M.D.

MEDICARE: DR. JOSE A. SERRANO-MARTINEZ M.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
1207Q00000XFamily Medicine Physician3126AK

General Provider Information

NPI Number : 1902897135
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE A. SERRANO-MARTINEZ M.D.
Provider Business Mailing Address
First Line : 2219 RAVEN DR
Second Line :
City : NORTH AUGUSTA
State : SC
Zip : 29841-2921
Country : US
Telephone Number : 803-442-3045
Fax Number :
Provider Business Practice Location Address
First Line : 501 GARY HILL RD
Second Line :
City : EDGEFIELD
State : SC
Zip : 29824-4503
Country : US
Telephone Number : 803-637-1425
Fax Number : 803-637-7191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2005
Last Update Date : 07/09/2007

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