Basic Information
| Provider Information | |||||||||
| NPI: | 1346689338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SERSHON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | AXEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 ARMY NAVY DR STE 307 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7037698486 | ||||||||
| Practice Location | |||||||||
| Address1: | 2445 ARMY NAVY DR STE 307 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7037698486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2013 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101264747 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | FS7648718 | 01 | VA | DEA | OTHER |