Provider Demographics
NPI:1538332895
Name:SERENITE MEDICAL & SPA INC
Entity Type:Organization
Organization Name:SERENITE MEDICAL & SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-441-1905
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-0998
Mailing Address - Country:US
Mailing Address - Phone:703-441-1905
Mailing Address - Fax:
Practice Address - Street 1:3771 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1946
Practice Address - Country:US
Practice Address - Phone:703-441-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE11822Medicare UPIN
VAC09739Medicare PIN