Provider Demographics
NPI:1528058278
Name:SERRELL, NANCY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:SERRELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:151 EVERETT AVE
Practice Address - Street 2:CHELSEA HEALTHCARE CENTER CHC
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1812
Practice Address - Country:US
Practice Address - Phone:617-884-8300
Practice Address - Fax:617-889-8579
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA42994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6172792Medicaid
MA042994OtherTUFTS HEALTH PLAN
MAM09760OtherBCBS MA
MA6172792Medicaid
MAM09760Medicare ID - Type Unspecified