MEDICARE: RICHARD R RENAUD M.D.

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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	57079	MA

General Provider Information

NPI Number	:	1386691087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD R RENAUD M.D.

Provider Business Mailing Address
First Line	:	54 MARY LOU CT
Second Line	:
City	:	RAYNHAM
State	:	MA
Zip	:	02767-5253
Country	:	US
Telephone Number	:	508-958-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 MARY LOU CT
Second Line	:
City	:	RAYNHAM
State	:	MA
Zip	:	02767-5253
Country	:	US
Telephone Number	:	508-958-6000
Fax Number	:	508-884-5676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	10/02/2014

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