Provider Demographics
NPI:1962596080
Name:VALACH, RENEE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ELIZABETH
Last Name:VALACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TAREYTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1242
Mailing Address - Country:US
Mailing Address - Phone:585-643-5432
Mailing Address - Fax:
Practice Address - Street 1:HOPITAL DE BONGOLO
Practice Address - Street 2:BP 49
Practice Address - City:LEBAMBA
Practice Address - State:NGOUNIE
Practice Address - Zip Code:999
Practice Address - Country:GA
Practice Address - Phone:585-643-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238878207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics