Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 23322 | NC |
NPI | 1528021359 |
---|---|
Provider Name | Dr. Donald Philip Renaldo |
First Address | Charlotte, NC 28204-3260 |
Second Address | Charlotte, NC 28204-3260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 04/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8971240 | (05) | NC |
C81099 | (02) | NC |