Provider Demographics
NPI:1508852468
Name:SERRANO, ERIC R (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:SERRANO
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 1:475 HILL RD N
Mailing Address - Street 2:P.O.BOX # 457
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1157
Mailing Address - Country:US
Mailing Address - Phone:614-833-5523
Mailing Address - Fax:614-833-5523
Practice Address - Street 1:475 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1157
Practice Address - Country:US
Practice Address - Phone:614-833-5523
Practice Address - Fax:614-833-5523
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0642759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0918298Medicaid
OH0918298Medicaid
OHF70509Medicare UPIN