Provider Demographics
NPI:1992874200
Name:COCKRELL, RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:SCHUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:
Practice Address - Street 1:141 STORAGE ROAD
Practice Address - Street 2:CHILDREN'S DEVELOPMENTAL SERVICES AGENCY
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-443-0318
Practice Address - Fax:252-443-5079
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45749Medicare UPIN