Provider Demographics
NPI:1366585523
Name:SERNEELS, RUTH ANN (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:SERNEELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1418
Mailing Address - Country:US
Mailing Address - Phone:606-337-9709
Mailing Address - Fax:
Practice Address - Street 1:206 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1418
Practice Address - Country:US
Practice Address - Phone:606-337-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26759208000000X
IN01040023A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F12310Medicare UPIN