Provider Demographics
NPI:1649296690
Name:JOSEPH, RENJU THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RENJU
Middle Name:THOMAS
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:STE 2700
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303
Mailing Address - Country:US
Mailing Address - Phone:864-583-0053
Mailing Address - Fax:864-583-0390
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:STE 2700
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-583-0053
Practice Address - Fax:864-583-0390
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27788208100000X
NC200600352208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571049338OtherBCBS
NC2056212AMedicare PIN
NC2056212Medicare PIN
SCI328836655Medicare PIN
I32883Medicare UPIN
SCI328835640Medicare PIN