1275512550 NPI number — RANDOLPH H RENZI MD

Table of content: RANDOLPH H RENZI MD (NPI 1275512550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275512550 NPI number — RANDOLPH H RENZI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENZI
Provider First Name:
RANDOLPH
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275512550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 CAMPUS BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-662-0306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 CAMPUS BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-662-0306
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  0101045302 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X , with the licence number: 18128 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E44029 . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: 091241700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16284 . This is a "OPTIMA HEALTH SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2119598 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C00075 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 502807 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 000674642 . This is a "MOUNTAIN STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0085714000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006036155 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9318661 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 068565 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".