Healthcare Provider Details

I. General information

NPI: 1528021359
Provider Name (Legal Business Name): DONALD PHILIP RENALDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 E 4TH ST STE. 908
CHARLOTTE NC
28204-3260
US

IV. Provider business mailing address

1718 E 4TH ST STE. 908
CHARLOTTE NC
28204-3260
US

V. Phone/Fax

Practice location:
  • Phone: 704-376-5424
  • Fax: 704-376-5354
Mailing address:
  • Phone: 704-376-5424
  • Fax: 704-376-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number23322
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: