Provider Demographics
NPI:1295773349
Name:RENNER, DEBRA A (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:RENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:REIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 HAGEN DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-922-0130
Mailing Address - Fax:585-922-1042
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-922-0130
Practice Address - Fax:585-922-1042
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190712207Q00000X
VA0101240877207Q00000X
NY190712-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02603276Medicaid
NYJ400201199Medicare PIN
NYJ400201300Medicare PIN