Provider Demographics
NPI:1790734937
Name:PABLO RENART MD
Entity Type:Organization
Organization Name:PABLO RENART MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-439-3252
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-270-2379
Mailing Address - Fax:301-270-2349
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-270-2379
Practice Address - Fax:301-270-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCD94108Medicare UPIN
DC187612Medicare ID - Type Unspecified