Provider Demographics
NPI:1689812695
Name:SERU, SARITHA (MD)
Entity Type:Individual
Prefix:
First Name:SARITHA
Middle Name:
Last Name:SERU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 PROGRESS WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9764
Mailing Address - Country:US
Mailing Address - Phone:503-981-5348
Mailing Address - Fax:503-981-0423
Practice Address - Street 1:2050 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9764
Practice Address - Country:US
Practice Address - Phone:503-981-5348
Practice Address - Fax:503-981-0423
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT-190062208000000X
ORMD151145208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500623773Medicaid