MEDICARE: RENU SONI 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	207R00000X	Internal Medicine Physician	38567	KY
2	207R00000X	Internal Medicine Physician	35.090471	OH
3	207R00000X	Internal Medicine Physician	257597	MA

General Provider Information

NPI Number	:	1649276585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENU SONI M.D.

Provider Business Mailing Address
First Line	:	133 BROOKLINE AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-3904
Country	:	US
Telephone Number	:	617-421-8843
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 BROOKLINE AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-3904
Country	:	US
Telephone Number	:	617-421-8843
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/17/2021

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