Individual
BILLY L RENICK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
900 CANTON AVENUE, BALTIMORE, MD 21229
(410) 368-2414
(410) 951-4007
Mailing address
PO BOX 21182, BALTIMORE, MD 21228
(410) 368-8640
(410) 368-8644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0001030
MD
Other
Enumeration date
03/24/2006
Last updated
07/08/2007
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