Provider Demographics
NPI:1760456214
Name:RENZI, STEPHEN JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:RENZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S RAILROAD ST
Mailing Address - Street 2:STATION SQUARE
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1499
Mailing Address - Country:US
Mailing Address - Phone:570-297-4555
Mailing Address - Fax:570-297-4777
Practice Address - Street 1:160 S RAILROAD ST
Practice Address - Street 2:STATION SQUARE
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1499
Practice Address - Country:US
Practice Address - Phone:570-297-4555
Practice Address - Fax:570-297-4777
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00179406OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
NY02588512Medicaid
PA1011167470001Medicaid
PAGU040074OtherPA MEDICARE GROUP
PA082848N93Medicare ID - Type Unspecified
PAGU040074OtherPA MEDICARE GROUP
PA082848YDFUMedicare PIN