Provider Demographics
NPI:1043372980
Name:MIDDLETOWN INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MIDDLETOWN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-378-4407
Mailing Address - Street 1:212 CARTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5837
Mailing Address - Country:US
Mailing Address - Phone:302-378-4407
Mailing Address - Fax:
Practice Address - Street 1:212 CARTER DR STE A
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5837
Practice Address - Country:US
Practice Address - Phone:302-378-4407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00271Medicare PIN