Provider Demographics
NPI:1750540217
Name:THOMAS G SERIO MD PA
Entity type:Organization
Organization Name:THOMAS G SERIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-656-5411
Mailing Address - Street 1:1802 MICCOSUKEE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5432
Mailing Address - Country:US
Mailing Address - Phone:850-656-5411
Mailing Address - Fax:850-656-5611
Practice Address - Street 1:1802 MICCOSUKEE COMMONS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5432
Practice Address - Country:US
Practice Address - Phone:850-656-5411
Practice Address - Fax:850-656-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377627100Medicaid
G01844Medicare UPIN