Provider Demographics
NPI:1336128768
Name:SERRIAN, JOHN L JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:SERRIAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0796
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 2020
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-375-6565
Practice Address - Fax:610-375-2065
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-045368-L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001584227Medicaid
PA885949Medicare PIN
G24761Medicare UPIN