Provider Demographics
NPI:1780614511
Name:ALLENBAUGH, RENEE M (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:ALLENBAUGH
Suffix:
Gender:F
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-371-3730
Mailing Address - Fax:814-371-9335
Practice Address - Street 1:100 MEADOW LN
Practice Address - Street 2:SUITE 4
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2460
Practice Address - Country:US
Practice Address - Phone:814-371-3730
Practice Address - Fax:814-371-9335
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-072985-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001770572Medicaid
PA037370Medicare ID - Type Unspecified
PA001770572Medicaid