Healthcare Provider Details

I. General information

NPI: 1225591092
Provider Name (Legal Business Name): CHARLES E RENNER III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N MEADOWS DR
GROVE CITY OH
43123-2546
US

IV. Provider business mailing address

5300 N MEADOWS DR
GROVE CITY OH
43123-2546
US

V. Phone/Fax

Practice location:
  • Phone: 614-663-4550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.156781
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: