Healthcare Provider Details

I. General information

NPI: 1740365121
Provider Name (Legal Business Name): RENAISSANCE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 N MAIN ST
PROVIDENCE RI
02904-5706
US

IV. Provider business mailing address

790 N MAIN ST
PROVIDENCE RI
02904-5706
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-3600
  • Fax: 401-272-3636
Mailing address:
  • Phone: 401-272-3600
  • Fax: 401-272-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TAREK WEHBE
Title or Position: OWNER
Credential: M.D.
Phone: 401-455-3574