Provider Demographics
NPI:1013946656
Name:SERIN, CRAIG DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DAVID
Last Name:SERIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:195 DANBURY RD
Mailing Address - Street 2:DAVENPORT BUILDING, SUITE 140
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4075
Mailing Address - Country:US
Mailing Address - Phone:203-762-3353
Mailing Address - Fax:203-761-8563
Practice Address - Street 1:195 DANBURY RD
Practice Address - Street 2:DAVENPORT BUILDING, SUITE 140
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4075
Practice Address - Country:US
Practice Address - Phone:203-762-3353
Practice Address - Fax:203-761-8563
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT039527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001395278Medicaid
CT001395278Medicaid
CTH41286Medicare UPIN