MEDICARE: FRANCIS SCOTT RENNA 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	207NS0135X	Procedural Dermatology Physician	36142	MA

Other Identifiers

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

General Provider Information

NPI Number	:	1780630160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCIS SCOTT RENNA M.D.

Provider Business Mailing Address
First Line	:	2000 WASHINGTON ST
Second Line	:	MOB BLUE 120
City	:	NEWTON LOWER FALLS
State	:	MA
Zip	:	02462-1650
Country	:	US
Telephone Number	:	617-969-0210
Fax Number	:	617-527-6019

Provider Business Practice Location Address
First Line	:	2000 WASHINGTON ST
Second Line	:	MOB BLUE 120
City	:	NEWTON LOWER FALLS
State	:	MA
Zip	:	02462-1650
Country	:	US
Telephone Number	:	617-969-0210
Fax Number	:	617-527-6019

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	12/14/2011

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