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NPI Code Detail

MEDICARE: DR. BETH ANNE RENZULLI MD

MEDICARE: DR. BETH ANNE RENZULLI 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
1207R00000XInternal Medicine PhysicianD0060425MD
2207R00000XInternal Medicine PhysicianC10007078DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073603031
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETH ANNE RENZULLI MD
Provider Business Mailing Address
First Line : 102 SLEEPY HOLLOW DRIVE, SUITE 200
Second Line :
City : MIDDLETOWN
State : DE
Zip : 19799
Country : US
Telephone Number : 302-449-0070
Fax Number : 302-613-7548
Provider Business Practice Location Address
First Line : 102 SLEEPY HOLLOW DR STE 200
Second Line :
City : MIDDLETOWN
State : DE
Zip : 19709-5841
Country : US
Telephone Number : 302-449-0070
Fax Number : 302-613-7548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 09/05/2017

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