Provider Demographics
NPI:1063463172
Name:WATERS, RENEE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER ANESTHESIA ASSOCIATES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-968-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068556000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010005236 00OtherAMERICHOICE
NJ3135788OtherAETNA
NJ3135793OtherAETNA
NJ2566481OtherUNITED HEALTHCARE
NJ331853OtherAMERIHEALTH PPO/PA BS
NJ0668917000OtherAMERIHEALTH/KEYSTONE/IBC
NJ7481004Medicaid
NJP3722607OtherOXFORD
NJ1171547OtherHORIZON NJ HEALTH
NJ24959OtherUNIVERSITY HEALTH PLAN
NJ60001741OtherHORIZON NJ HEALTH
NJ7481004Medicaid
NJ034669 DLFMedicare PIN
NJ331853OtherAMERIHEALTH PPO/PA BS
NJ1171547OtherHORIZON NJ HEALTH