Provider Demographics
NPI:1528021359
Name:RENALDO, DONALD PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PHILIP
Last Name:RENALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1718 E 4TH ST
Mailing Address - Street 2:STE. 908
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3260
Mailing Address - Country:US
Mailing Address - Phone:704-376-5424
Mailing Address - Fax:704-376-5354
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:STE. 908
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3260
Practice Address - Country:US
Practice Address - Phone:704-376-5424
Practice Address - Fax:704-376-5354
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC23322156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971240Medicaid
NC8971240Medicaid
NCC81099Medicare UPIN