MEDICARE: CYNTHIA ROSE RENAULD-LANSING D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	173802	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477550929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ROSE RENAULD-LANSING D.O.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 S PEARL ST
Second Line	:	ST. PETER'S HOSPITAL FAMILY HEALTH CENTER
City	:	ALBANY
State	:	NY
Zip	:	12202-1914
Country	:	US
Telephone Number	:	518-449-0100
Fax Number	:	518-463-8580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/10/2021

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