Provider Demographics
NPI:1285671537
Name:PAKEEREE, RENGA A (MD)
Entity Type:Individual
Prefix:MR
First Name:RENGA
Middle Name:A
Last Name:PAKEEREE
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 1:275 GRAHAM RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-923-5796
Mailing Address - Fax:330-923-0926
Practice Address - Street 1:275 GRAHAM RD
Practice Address - Street 2:SUITE 10
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-923-5796
Practice Address - Fax:330-923-0926
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041600P2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399484Medicaid
OHPA0464972Medicare PIN
OH0399484Medicaid