Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 220496 | MA |
N | 111NI0900X | Internist | 220496 | MA |
Y | 207RG0300X | Geriatric Medicine | 220496 | MA |
NPI | 1053375840 |
---|---|
Provider Name | Serena H Chao |
First Address | Everett, MA 02149-5066 |
Second Address | Everett, MA 02149-5066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 01/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110038022A | (05) | MA |
I10790 | (02) | MA |