Provider Demographics
NPI:1821409764
Name:DUPREE, RENELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RENELL
Middle Name:
Last Name:DUPREE
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 1:8250 OLD YORK RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1514
Mailing Address - Country:US
Mailing Address - Phone:215-886-0440
Mailing Address - Fax:215-886-0447
Practice Address - Street 1:8250 OLD YORK RD FL 2
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1514
Practice Address - Country:US
Practice Address - Phone:215-886-0440
Practice Address - Fax:215-886-0447
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103281928Medicaid