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NPI Code Detail

MEDICARE: TAD T RENVYLE MD

MEDICARE: TAD T RENVYLE 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
12085R0202XDiagnostic Radiology Physician11573NH
22085R0202XDiagnostic Radiology PhysicianMD20616ME

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 : 1437122231
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAD T RENVYLE MD
Provider Business Mailing Address
First Line : 703 RIVERWAY PL
Second Line :
City : BEDFORD
State : NH
Zip : 03110-6745
Country : US
Telephone Number : 603-627-1661
Fax Number : 603-669-6944
Provider Business Practice Location Address
First Line : 703 RIVERWAY PL
Second Line :
City : BEDFORD
State : NH
Zip : 03110-6745
Country : US
Telephone Number : 603-627-1661
Fax Number : 603-669-6944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 07/30/2025

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Directions to “ TAD T RENVYLE MD” Practice Location

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