Provider Demographics
NPI:1588732424
Name:BOVELLE, RENEE C (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:BOVELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12200 ANNAPOLIS RD STE 116
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-805-4664
Mailing Address - Fax:301-805-4663
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 116
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-805-4664
Practice Address - Fax:301-805-4663
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD32558207WX0120X
MDD0056686207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG30564Medicare UPIN