Provider Demographics
NPI:1497245351
Name:RENICK, ELAINE CRONE (DO)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CRONE
Last Name:RENICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAMILY MEDICINE CENTER
Mailing Address - Street 2:3209 COLONIAL DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6113
Mailing Address - Fax:803-434-8478
Practice Address - Street 1:415 S POLLARD ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-2502
Practice Address - Country:US
Practice Address - Phone:540-983-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL51963207Q00000X
VA0102206503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine