Provider Demographics
NPI:1740365121
Name:RENAISSANCE MEDICAL GROUP
Entity type:Organization
Organization Name:RENAISSANCE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-455-3574
Mailing Address - Street 1:790 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5706
Mailing Address - Country:US
Mailing Address - Phone:401-272-3600
Mailing Address - Fax:401-272-3636
Practice Address - Street 1:790 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5706
Practice Address - Country:US
Practice Address - Phone:401-272-3600
Practice Address - Fax:401-272-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty