Provider Demographics
NPI:1801896451
Name:RENICK, PHILLIP M (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:RENICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4059 QUARLES CT
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8717
Mailing Address - Country:US
Mailing Address - Phone:540-437-4800
Mailing Address - Fax:540-437-9012
Practice Address - Street 1:4059 QUARLES CT
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8717
Practice Address - Country:US
Practice Address - Phone:540-437-4800
Practice Address - Fax:540-437-9012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101231065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics