Provider Demographics
NPI:1841525508
Name:SERGE LARTCHENKO, MD, PA
Entity type:Organization
Organization Name:SERGE LARTCHENKO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARTCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-300-1364
Mailing Address - Street 1:9603 WHITE ROCK TRAIL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5039
Mailing Address - Country:US
Mailing Address - Phone:972-644-8577
Mailing Address - Fax:972-644-8056
Practice Address - Street 1:2320 HUGO ST
Practice Address - Street 2:#1901
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2801
Practice Address - Country:US
Practice Address - Phone:214-300-1364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty