Provider Demographics
NPI:1912907452
Name:SERALY, MARK PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:SERALY
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 1:222 E MCMURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2948
Mailing Address - Country:US
Mailing Address - Phone:724-969-2500
Mailing Address - Fax:724-969-2510
Practice Address - Street 1:222 E MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2948
Practice Address - Country:US
Practice Address - Phone:724-969-2500
Practice Address - Fax:724-969-2510
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052489L207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA758035Medicare ID - Type Unspecified
PAF75792Medicare UPIN