Healthcare Provider Details

I. General information

NPI: 1740910637
Provider Name (Legal Business Name): RENANA YEMINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 01/22/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE STREET MAILBOX 800136
CHARLOTTESVILLE VA
22908-9311
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-3627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0116036182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: