MEDICARE: ANTHONY JAMES RODA-RENZELLI 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	207R00000X	Internal Medicine Physician	21996	WV
2	207RI0011X	Interventional Cardiology Physician	21996	WV

General Provider Information

NPI Number	:	1992803506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JAMES RODA-RENZELLI MD

Provider Business Mailing Address
First Line	:	2000 MON HEALTH MEDICAL PARK DR STE 2300
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1168
Country	:	US
Telephone Number	:	304-599-8802
Fax Number	:	304-599-5607

Provider Business Practice Location Address
First Line	:	2000 MON HEALTH MEDICAL PARK DR STE 2300
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1168
Country	:	US
Telephone Number	:	304-599-8802
Fax Number	:	304-599-5607

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/05/2023

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