Provider Demographics
NPI:1710903703
Name:RENDA, PAUL V (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:V
Last Name:RENDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6523
Mailing Address - Country:US
Mailing Address - Phone:757-473-0055
Mailing Address - Fax:
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6087361Medicaid
VA5709121Medicaid
VA5709121Medicaid
B09655Medicare UPIN
50000811Medicare ID - Type Unspecified