Provider Demographics
NPI:1679508543
Name:RENAISANCE FAMILY PRACTICE, INC
Entity Type:Organization
Organization Name:RENAISANCE FAMILY PRACTICE, INC
Other - Org Name:RFP/GLENSHAW GIBSONIA DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-274-9451
Mailing Address - Street 1:600 WATERCREST WAY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1370
Mailing Address - Country:US
Mailing Address - Phone:724-274-9420
Mailing Address - Fax:724-274-9370
Practice Address - Street 1:619 MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15223-1225
Practice Address - Country:US
Practice Address - Phone:412-487-4422
Practice Address - Fax:412-487-6930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068624OtherHIGHMARK DIVISION