Provider Demographics
NPI:1841411824
Name:WEISS, RENU (MD)
Entity type:Individual
Prefix:DR
First Name:RENU
Middle Name:
Last Name:WEISS
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 1:4000 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1017
Mailing Address - Country:US
Mailing Address - Phone:717-231-8867
Mailing Address - Fax:717-231-8535
Practice Address - Street 1:4000 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1017
Practice Address - Country:US
Practice Address - Phone:717-231-8867
Practice Address - Fax:717-231-8535
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057122A207R00000X, 208M00000X
OH35.137613207R00000X
PAMD469113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01057122AOtherLICENSE NUMBER
INP01214653OtherRR MEDICARE PTAN
IN201033120Medicaid
INP01214653OtherRR MEDICARE PTAN
IN01057122AOtherLICENSE NUMBER
INI31666Medicare UPIN
IN251320011Medicare PIN