Provider Demographics
NPI:1780645713
Name:SERIATOS, TIMOTHEA (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHEA
Middle Name:
Last Name:SERIATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIMOTHEA
Other - Middle Name:
Other - Last Name:ELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:116 S GEORGE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1443
Mailing Address - Country:US
Mailing Address - Phone:717-801-4821
Mailing Address - Fax:717-854-0377
Practice Address - Street 1:116 S GEORGE ST STE 200
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1443
Practice Address - Country:US
Practice Address - Phone:717-845-8617
Practice Address - Fax:717-854-6645
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064293L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020453540001Medicaid
PA01398102OtherCAPITAL BLUE CROSS
PA21120OtherHIGHMARK BLUE SHIELD
PA01398102OtherCAPITAL BLUE CROSS
G75746Medicare UPIN
PA1020453540001Medicaid
PA256476YEBKMedicare PIN