Provider Demographics
NPI:1710998877
Name:PRINCE, RENEE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PRINCE
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 1:7 ELM ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3669
Mailing Address - Country:US
Mailing Address - Phone:860-763-4041
Mailing Address - Fax:860-763-5221
Practice Address - Street 1:7 ELM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3669
Practice Address - Country:US
Practice Address - Phone:860-763-4041
Practice Address - Fax:860-763-5221
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169569207X00000X
NJ50622207X00000X
CT029049207X00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001290494Medicaid
D02647Medicare UPIN
CT001290494Medicaid