Provider Demographics
NPI:1538499173
Name:DE GOLOVINE, SERGE (MD)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:DE GOLOVINE
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 1:4710 BELLAIRE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4526
Mailing Address - Country:US
Mailing Address - Phone:713-661-1444
Mailing Address - Fax:713-661-6604
Practice Address - Street 1:4710 BELLAIRE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4526
Practice Address - Country:US
Practice Address - Phone:713-661-1444
Practice Address - Fax:713-661-6604
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN0720207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB110419Medicare PIN