Provider Demographics
NPI:1689881567
Name:SEROTA, PEARL FISHER (MD,)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:FISHER
Last Name:SEROTA
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:PEARL
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7115
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-7115
Mailing Address - Country:US
Mailing Address - Phone:314-307-7600
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 693A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8263
Practice Address - Country:US
Practice Address - Phone:314-251-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1026832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry