Provider Demographics
NPI:1073603031
Name:RENZULLI, BETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANNE
Last Name:RENZULLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SLEEPY HOLLOW DRIVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19799
Mailing Address - Country:US
Mailing Address - Phone:302-449-0070
Mailing Address - Fax:302-613-7548
Practice Address - Street 1:102 SLEEPY HOLLOW DR STE 200
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5841
Practice Address - Country:US
Practice Address - Phone:302-449-0070
Practice Address - Fax:302-613-7548
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060425207R00000X
DEC10007078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034261Medicaid
DE1000034261Medicaid
025MH433Medicare ID - Type Unspecified