Provider Demographics
NPI:1992796502
Name:RENNERT, DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:RENNERT
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 1:19455 DEERFIELD AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-858-9608
Mailing Address - Fax:703-858-9618
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-858-9608
Practice Address - Fax:702-858-9618
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043761207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5854466Medicaid
DCA6950002OtherDC BS
E36655Medicare UPIN
VA5854466Medicaid
DCA6950002OtherDC BS
VA290000262Medicare ID - Type UnspecifiedVA MEDICARE