Provider Demographics
NPI:1619968625
Name:SORRENTINO, RENEE M (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:M
Last Name:SORRENTINO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLK 11 PSYCHIATRY ASSOCIATES INPATIENT CONSULT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-626-8533
Practice Address - Fax:617-626-8669
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2016-01-27
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Provider Licenses
StateLicense IDTaxonomies
MA2078422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469487OtherTUFTS HEALTH PLAN
MA2077191Medicaid
MAJ27872OtherBCBS MA
MA2077191Medicaid
MAA36268Medicare ID - Type Unspecified