Provider Demographics
NPI:1386639805
Name:DEE, SERENA E H (MD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:E H
Last Name:DEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4396
Mailing Address - Country:US
Mailing Address - Phone:978-629-2400
Mailing Address - Fax:978-683-0663
Practice Address - Street 1:700 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4396
Practice Address - Country:US
Practice Address - Phone:978-629-2400
Practice Address - Fax:978-683-0663
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303775Medicaid
MA1303775Medicaid
MAB11802Medicare ID - Type Unspecified