Provider Demographics
NPI:1508890708
Name:UMANZOR, RENE A (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:A
Last Name:UMANZOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2205
Practice Address - Country:US
Practice Address - Phone:978-465-4169
Practice Address - Fax:978-466-4017
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151147207R00000X, 207RG0300X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
151147OtherCONNECTICARE
69641OtherHARVARD PILGRIM
G60441Medicare UPIN
984992OtherNETWORK HEALTH
151147OtherTUFTS COMMUNITY HEALTH PL
110209009OtherRAILROAD MEDICARE
3547815OtherHEALTHSOURCE CMHC
1023991OtherCIGNA
J22088OtherBLUE CROSS BLUE SHIELD
64786OtherFALLON COMMUNITY HEALTH P
A31063Medicare ID - Type Unspecified
MA0110850Medicaid