Provider Demographics
NPI:1568573632
Name:THEODORE RENNA, MD PA
Entity Type:Organization
Organization Name:THEODORE RENNA, MD PA
Other - Org Name:MONADNOCK EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-924-7070
Mailing Address - Street 1:454 OLD STREET RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1200
Mailing Address - Country:US
Mailing Address - Phone:603-924-7070
Mailing Address - Fax:603-924-6700
Practice Address - Street 1:454 OLD STREET RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1200
Practice Address - Country:US
Practice Address - Phone:603-924-7070
Practice Address - Fax:603-924-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30210243Medicaid
NH30210243Medicaid
NHRE4707Medicare ID - Type UnspecifiedGROUP PROVIDER ID