Provider Demographics
NPI:1992717276
Name:RENE, RONALD MARSHEL (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARSHEL
Last Name:RENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARSHEL
Other - Middle Name:RONALD
Other - Last Name:RENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2611 RAMEY DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28356-9627
Mailing Address - Country:US
Mailing Address - Phone:910-584-0730
Mailing Address - Fax:843-937-6110
Practice Address - Street 1:1100 TUNNEL RD
Practice Address - Street 2:VA MEDICAL CENTER, DEPT. OF SURGERY
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2576
Practice Address - Country:US
Practice Address - Phone:828-298-7911
Practice Address - Fax:828-299-2567
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27556208600000X
NC2001-00597208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01162358Medicaid
NC136G9Medicaid
NC136G9Medicaid
NYE40742Medicare UPIN
NY38F111Medicare ID - Type UnspecifiedMC/BCBS