Provider Demographics
NPI:1649258393
Name:RENY, MICHAEL F (BS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:RENY
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Gender:M
Credentials:BS
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Mailing Address - Street 1:43 SMITH ROAD
Mailing Address - Street 2:PROFESSIONAL AFFAIRS
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841-1002
Mailing Address - Country:US
Mailing Address - Phone:401-841-4522
Mailing Address - Fax:401-841-4128
Practice Address - Street 1:650 SEWALL ST
Practice Address - Street 2:BRANCH HEALTH CLINIC NAVAL AIR STATION
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-5011
Practice Address - Country:US
Practice Address - Phone:207-921-1820
Practice Address - Fax:207-921-2992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
ME1038302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN