Provider Demographics
NPI:1508987843
Name:RENE N. VAMENTA, M.D.
Entity Type:Organization
Organization Name:RENE N. VAMENTA, M.D.
Other - Org Name:CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAMENTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-483-2849
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:681 S MAIN STREET
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-0624
Mailing Address - Country:US
Mailing Address - Phone:540-483-2849
Mailing Address - Fax:
Practice Address - Street 1:681 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1750
Practice Address - Country:US
Practice Address - Phone:540-483-2849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty