Basic Information
| Provider Information | |||||||||
| NPI: | 1730414293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENZI | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 819 WORCESTER ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011511056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135436820 | ||||||||
| FaxNumber: | 4135437962 | ||||||||
| Practice Location | |||||||||
| Address1: | 819 WORCESTER ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | INDIAN ORCHARD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011511056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135436820 | ||||||||
| FaxNumber: | 4135437962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2009 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 055122 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DO00865 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2007860 | 05 | WA | MEDICAID |