Provider Demographics
NPI:1003078924
Name:N.K. RENAUD, M.D. P.C.
Entity Type:Organization
Organization Name:N.K. RENAUD, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:KYONGNAN
Authorized Official - Last Name:RENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-486-3991
Mailing Address - Street 1:1715 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3409
Mailing Address - Country:US
Mailing Address - Phone:703-486-3991
Mailing Address - Fax:
Practice Address - Street 1:2805 COLUMBIA PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4411
Practice Address - Country:US
Practice Address - Phone:703-486-3991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231439207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01596Medicare PIN