Provider Demographics
NPI:1033174727
Name:RENNIE, VICTORIA A (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:RENNIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:R
Other - Last Name:HEDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:1260 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2984
Practice Address - Country:US
Practice Address - Phone:804-518-2597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005317P95Medicare PIN
MD351018YWV2Medicare PIN
MD238853ZDDB - 149619Medicare PIN
VA021030P95 - C03895Medicare PIN
MD238853YVZ - (945L)Medicare PIN
VAE12232Medicare UPIN