Provider Demographics
NPI:1346236809
Name:RENNARD, THOMAS W (M D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:RENNARD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ASHELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4013
Mailing Address - Country:US
Mailing Address - Phone:828-258-1188
Mailing Address - Fax:828-251-1801
Practice Address - Street 1:147 ASHELAND AVENUE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4013
Practice Address - Country:US
Practice Address - Phone:828-258-1188
Practice Address - Fax:828-251-1801
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148393207R00000X
NC35733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971269Medicaid
NC71269OtherBCBS
NC110132170OtherRAILROAD MEDICARE
NC2183620Medicaid
NC0470561OtherU NITED HEALTHCARE
NCF52396Medicare UPIN
NC2183620Medicaid
NC8971269Medicaid
21836920Medicare ID - Type Unspecified