Individual
MANUEL J JIMENEZ-SERRANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
709 DELAWARE AVE, FOUNTAIN HILL, PA 18015-1107
(484) 526-3890
(484) 526-3046
Mailing address
709 DELAWARE AVE, FOUNTAIN HILL, PA 18015-1107
(484) 526-3890
(484) 526-3046
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD429800
PA
207RP1001X
Pulmonary Disease Physician
Primary
MD429800
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018206400001
—
PA
05
—
1018206400002
—
PA
01
—
2094414
HIGHMARK BLUE SHIELD
PA
01
—
2854839000
BCBS - PA
PA
Enumeration date
06/26/2006
Last updated
09/12/2013
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