Provider Demographics
NPI:1538179403
Name:RENZELLI-CAIN, ROBERTA (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:RENZELLI-CAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GALLERY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:724-884-0898
Mailing Address - Fax:
Practice Address - Street 1:122 GALLERY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:724-884-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013446207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012279980003Medicaid
PA127789Medicare PIN
PA1012279980003Medicaid