Provider Demographics
NPI:1356319305
Name:RENZETTI, MARGARET ELLEN (DC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ELLEN
Last Name:RENZETTI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1927
Mailing Address - Country:US
Mailing Address - Phone:410-221-0781
Mailing Address - Fax:410-476-3400
Practice Address - Street 1:421 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1927
Practice Address - Country:US
Practice Address - Phone:410-221-0781
Practice Address - Fax:410-476-3400
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39826Medicare UPIN