Individual
RICHARD RENZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 KENYON AVE, WAKEFIELD, RI 02879-4299
(401) 782-8000
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD07004
RI
207P00000X
Emergency Medicine Physician
MD18266
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578579678
NPI
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
05
—
RR07053
—
RI
Enumeration date
07/31/2006
Last updated
10/13/2022
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