Healthcare Provider Details

I. General information

NPI: 1275645400
Provider Name (Legal Business Name): GREGORY R RENCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COMMONWEALTH CT STE H
CARY NC
27511-4437
US

IV. Provider business mailing address

PO BOX 208
LELAND NC
28451-0208
US

V. Phone/Fax

Practice location:
  • Phone: 919-465-1443
  • Fax:
Mailing address:
  • Phone: 703-766-6555
  • Fax: 800-731-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35C.003153
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9801459
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9801459
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25504
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27514
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-11057
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number56055
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: