Healthcare Provider Details

I. General information

NPI: 1033161872
Provider Name (Legal Business Name): PAUL T. RENAUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY MC 845
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY MC 845
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1206
  • Fax: 207-626-1648
Mailing address:
  • Phone: 207-626-1206
  • Fax: 207-626-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number085922
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberEL181033
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: