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General NPI Number Information
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NPI Number | 1881715944
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Entity Type | Individual
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Provider Name | ELIZABETH J RENAUD M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 2 DUDLEY ST STE 190
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City | PROVIDENCE
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State | RI
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Zip | 02905-3248
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Country | US
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Telephone | 401-228-0555
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Fax | 401-868-2319
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Provider Business Mailing Address
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Address Line | PO BOX 16149
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City | RUMFORD
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State | RI
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Zip | 02916-0697
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Country | US
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Telephone | 401-453-9625
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Fax | 401-435-7069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | MD16025
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 262737
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 216251
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License Number State | MA
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