Provider Demographics
NPI:1922080126
Name:SERRANO, MARIASTELLA (MD)
Entity Type:Individual
Prefix:
First Name:MARIASTELLA
Middle Name:
Last Name:SERRANO
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 1:4200 WISCONSIN AVE NW STE 400
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2100
Mailing Address - Country:US
Mailing Address - Phone:202-243-3558
Mailing Address - Fax:877-680-5504
Practice Address - Street 1:4200 WISCONSIN AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2100
Practice Address - Country:US
Practice Address - Phone:202-243-3558
Practice Address - Fax:877-680-5504
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0458652080P0206X
LAMD2034332080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0435776Medicaid
LA1113905Medicaid
MS08172388Medicaid
LA1113905Medicaid
I15776Medicare ID - Type Unspecified
LA4M4357061Medicare PIN