Provider Demographics
NPI:1821134149
Name:SANDERS, RENATA ARRINGTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATA
Middle Name:ARRINGTON
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RENATA
Other - Middle Name:GAYLE
Other - Last Name:ARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:SUITE M975
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3364
Mailing Address - Country:US
Mailing Address - Phone:410-955-2910
Mailing Address - Fax:
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3364
Practice Address - Country:US
Practice Address - Phone:215-590-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD482573207R00000X, 207RA0000X, 2080A0000X
MDD0064838207R00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014164000Medicaid
PA1821134149Medicaid