Provider Demographics
NPI:1336153311
Name:SERBIN, PHILIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:SERBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3977
Mailing Address - Country:US
Mailing Address - Phone:423-581-6084
Mailing Address - Fax:423-581-6078
Practice Address - Street 1:701 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3977
Practice Address - Country:US
Practice Address - Phone:423-581-6084
Practice Address - Fax:423-581-6078
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043057A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370OtherMEDICAID GROUP NUMBER
IN100462170Medicaid
TNQ005360Medicaid
IN340017214OtherMEDICARE RAILROAD
IN000000091700OtherANTHEM PROVIDER NUMBER
TN103I348047Medicare PIN
IN069350GMedicare PIN
IN000000091700OtherANTHEM PROVIDER NUMBER
IN100462170Medicaid
IN145840BMedicare PIN
IN318870NMedicare PIN
INB26354Medicare UPIN
TNQ005360Medicaid
IN340017214OtherMEDICARE RAILROAD
IN100194370OtherMEDICAID GROUP NUMBER
IN069340GMedicare PIN