Provider Demographics
NPI:1821015900
Name:SERKIN, FAYE BLACKER (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:BLACKER
Last Name:SERKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FAYE
Other - Middle Name:ADINA
Other - Last Name:BLACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1050 W PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762-6601
Mailing Address - Country:US
Mailing Address - Phone:240-857-6048
Mailing Address - Fax:
Practice Address - Street 1:1050 W PERIMETER RD
Practice Address - Street 2:
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238851208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology