Provider Demographics
NPI:1538228549
Name:SERLO, CHRIS H (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:H
Last Name:SERLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15201 SHADY GROVE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3217
Mailing Address - Country:US
Mailing Address - Phone:301-921-0009
Mailing Address - Fax:301-921-0019
Practice Address - Street 1:15201 SHADY GROVE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3217
Practice Address - Country:US
Practice Address - Phone:301-921-0009
Practice Address - Fax:301-921-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD00638213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT289OtherCAREFIRST BCBS
MD34050-8700Medicaid
4243656OtherAETNA PPO
2300969OtherAETNA HMO
52-1346837OtherTAX ID#
21651OtherMDIPA OPTIMUM CHOICE
DC6387OtherBLUE CROSS BLUE SHIELD
480002670Medicare ID - Type UnspecifiedMEDICARE RAILROAD
T30795Medicare UPIN
0904690001Medicare NSC
2300969OtherAETNA HMO