Provider Demographics
NPI:1588668131
Name:SEROTA, FREDRIC TOBIN (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:TOBIN
Last Name:SEROTA
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S BETHLEHEM PIKE
Mailing Address - Street 2:STE D
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5800
Mailing Address - Country:US
Mailing Address - Phone:215-643-7771
Mailing Address - Fax:215-643-9460
Practice Address - Street 1:602 S BETHLEHEM PIKE
Practice Address - Street 2:STE D
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5800
Practice Address - Country:US
Practice Address - Phone:215-643-7771
Practice Address - Fax:215-643-9460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013478E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025834Medicaid