Provider Demographics
NPI:1427059773
Name:ESPINA, RENATO R (MD)
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:R
Last Name:ESPINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 SETON DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1873
Mailing Address - Country:US
Mailing Address - Phone:301-723-5863
Mailing Address - Fax:301-723-5654
Practice Address - Street 1:902 SETON DR
Practice Address - Street 2:SUITE 301
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1873
Practice Address - Country:US
Practice Address - Phone:301-723-5863
Practice Address - Fax:301-723-5654
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-09-11
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
MDD0003459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001678530002Medicaid
DCG362 0001OtherBLUE CHOICE
MD192021900Medicaid
MD40290002OtherCAREFIRST BC BS
MD408113085OtherTRAVELERS MEDICARE
WV001716849OtherMT. STATE BC BS
WV0077675000Medicaid
MDGT51Medicare PIN
MD40290002OtherCAREFIRST BC BS