MEDICARE: RENATE N CHEVLI 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
1	207VG0400X	Gynecology Physician	112391	NY

General Provider Information

NPI Number	:	1609837251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATE N CHEVLI MD

Provider Business Mailing Address
First Line	:	5112 W TAFT RD
Second Line	:	SUITE L
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-4868
Country	:	US
Telephone Number	:	315-452-2500
Fax Number	:	315-452-2510

Provider Business Practice Location Address
First Line	:	4117 MEDICAL CENTER DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-6600
Country	:	US
Telephone Number	:	315-329-4968
Fax Number	:	315-452-2510

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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