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NPI Code Detail

MEDICARE: RENA BURLINGAME RENGO MD

MEDICARE: RENA BURLINGAME RENGO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician2008-00705NC
2207ZD0900XDermatopathology (Pathology) Physician2008-00705NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00445423OTHERNCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1148U6OTHERNCBCBS OF NC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053591602
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENA BURLINGAME RENGO MD
Provider Business Mailing Address
First Line : 203 INDIGO DR
Second Line :
City : BRUNSWICK
State : GA
Zip : 31525-6865
Country : US
Telephone Number : 912-261-2669
Fax Number :
Provider Business Practice Location Address
First Line : 203 INDIGO DR
Second Line :
City : BRUNSWICK
State : GA
Zip : 31525-6865
Country : US
Telephone Number : 912-261-2669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2007
Last Update Date : 12/14/2012

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