Provider Demographics
NPI:1386687507
Name:SERRAO, RICHARD ALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALDO
Last Name:SERRAO
Suffix:
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 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:111-ID
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VA BOSTON HEALTHCARE SYSTEM
Practice Address - Street 2:150 SOUTH HUNTINGTON AVE, 111-ID
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:857-364-4669
Practice Address - Fax:857-364-4564
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205822208M00000X, 207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASE A31907Medicare ID - Type UnspecifiedMEDICARE B
MAH29469Medicare UPIN