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General NPI Number Information
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NPI Number | 1740365121
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL GROUP
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 790 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5706
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Country | US
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Telephone | 401-272-3600
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Fax | 401-272-3636
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Provider Business Mailing Address
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Address Line | 790 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5706
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Country | US
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Telephone | 401-272-3600
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Fax | 401-272-3636
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAREK WEHBE
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Credential | M.D.
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Telephone | 401-455-3574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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