Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS005407L | PA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS005407L | PA |
NPI | 1073552840 |
---|---|
Provider Name | Thomas J Renaldo |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18103-6256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0040725000 | KEYSTONE EAST (01) | PA |
138086 | HIGHMARK BLUE SHIELD (01) | PA |
50004441 | CAPITAL BLUE CROSS (01) | PA |
80095184 | RAILROAD MEDICARE (01) | PA |
B38828 | (02) | PA |