Provider Demographics
NPI:1679761472
Name:RENGEN NEPHROLOGY LLC
Entity Type:Organization
Organization Name:RENGEN NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPREITOR
Authorized Official - Prefix:
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-344-9267
Mailing Address - Street 1:405 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4505
Mailing Address - Country:US
Mailing Address - Phone:240-344-9267
Mailing Address - Fax:
Practice Address - Street 1:405 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4505
Practice Address - Country:US
Practice Address - Phone:240-344-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-07
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0065835207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty