Provider Demographics
NPI:1558320929
Name:SERRANO, ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
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 1:50 ROWE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3201
Mailing Address - Country:US
Mailing Address - Phone:781-979-6500
Mailing Address - Fax:781-665-3834
Practice Address - Street 1:50 ROWE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3201
Practice Address - Country:US
Practice Address - Phone:781-979-6500
Practice Address - Fax:781-665-3834
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39133208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2046008Medicaid
A36108Medicare UPIN
MA2046008Medicaid