Provider Demographics
NPI:1033303854
Name:RICHARD R RENAUD, M.D.,P.C.
Entity Type:Organization
Organization Name:RICHARD R RENAUD, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-822-1514
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-7407
Mailing Address - Country:US
Mailing Address - Phone:508-822-1514
Mailing Address - Fax:
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-7407
Practice Address - Country:US
Practice Address - Phone:508-822-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57079207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9710361Medicaid
MA9710361Medicaid
MA4285390001Medicare NSC