Provider Demographics
NPI:1295726891
Name:RENCIC, ADRIENNE (MD PHD)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:
Last Name:RENCIC
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 RASPBERRY LANE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382
Mailing Address - Country:US
Mailing Address - Phone:610-283-2955
Mailing Address - Fax:610-281-3024
Practice Address - Street 1:534 RASPBERRY LANE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382
Practice Address - Country:US
Practice Address - Phone:610-283-2955
Practice Address - Fax:610-281-3024
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422146174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH61341Medicare UPIN