Healthcare Provider Details

I. General information

NPI: 1093449845
Provider Name (Legal Business Name): RENU PANERU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W OAK ST
TITUSVILLE PA
16354-1499
US

IV. Provider business mailing address

406 W OAK ST
TITUSVILLE PA
16354-1499
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-9770
  • Fax: 814-827-3556
Mailing address:
  • Phone: 814-827-9770
  • Fax: 814-827-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD487019
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: