Provider Demographics
NPI:1790872463
Name:QUARTERMAN, RENEE LAVERNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LAVERNE
Last Name:QUARTERMAN
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 1:1941 LIMESTONE RD STE 216
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5400
Mailing Address - Country:US
Mailing Address - Phone:302-386-8686
Mailing Address - Fax:302-386-8687
Practice Address - Street 1:1941 LIMESTONE RD STE 216
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-386-8686
Practice Address - Fax:302-386-8687
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24591208600000X
PAMD452792208600000X
DEC1-0013120208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227375Medicaid
H95878Medicare UPIN
OR227375Medicaid