Provider Demographics
NPI:1245323443
Name:SERLE, MICHAEL T (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:SERLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8707
Mailing Address - Country:US
Mailing Address - Phone:910-295-4400
Mailing Address - Fax:910-295-2810
Practice Address - Street 1:30 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8707
Practice Address - Country:US
Practice Address - Phone:910-295-4400
Practice Address - Fax:910-295-2810
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759320Medicare PIN