Provider Demographics
NPI:1679506166
Name:REN, JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E WT HARRIS BLVD
Mailing Address - Street 2:BUILDING 3000, SUITE 3301
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3485
Mailing Address - Country:US
Mailing Address - Phone:704-548-6970
Mailing Address - Fax:704-548-6279
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:BUILDING 3000, SUITE 3301
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-548-6970
Practice Address - Fax:704-548-6279
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905004Medicaid
NCP00382811Medicare ID - Type UnspecifiedRR HFP
NC5905004Medicaid
NC2046192Medicare ID - Type Unspecified