Individual
RENA BURLINGAME RENGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
203 INDIGO DR, BRUNSWICK, GA 31525-6865
(912) 261-2669
Mailing address
203 INDIGO DR, BRUNSWICK, GA 31525-6865
(912) 261-2669
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
2008-00705
NC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2008-00705
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148U6
BCBS OF NC
NC
05
—
5909325
—
NC
01
—
P00445423
RAILROAD MEDICARE
NC
Enumeration date
11/13/2007
Last updated
12/14/2012
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