Provider Demographics
NPI:1376957308
Name:RENFRO, MARY (CFM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RENFRO
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 SAINT LEOS ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3382
Mailing Address - Country:US
Mailing Address - Phone:336-621-9500
Mailing Address - Fax:336-621-0980
Practice Address - Street 1:8310 MEDICAL PLAZA DR
Practice Address - Street 2:STE C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6701
Practice Address - Country:US
Practice Address - Phone:704-510-1300
Practice Address - Fax:704-510-1311
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC02849224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter