Provider Demographics
NPI:1275512550
Name:RENZI, RANDOLPH H (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:H
Last Name:RENZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-662-0306
Mailing Address - Fax:
Practice Address - Street 1:1880 AMHERST STREET
Practice Address - Street 2:SUITE 100 AND SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:855-264-2066
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18128207RI0011X
VA0101045302207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0085714000Medicaid
WV000674642OtherMOUNTAIN STATE BCBS
VA502807OtherNCPPO
VA006036155Medicaid
WV9318661OtherMEDICARE GROUP
MD091241700Medicaid
VA16284OtherOPTIMA HEALTH SENTARA
VA068565OtherANTHEM BCBS
VA2119598OtherMAMSI
VAC00075OtherMEDICARE GROUP
VA068565OtherANTHEM BCBS
MD091241700Medicaid
VA068565OtherANTHEM BCBS
VA502807OtherNCPPO