Provider Demographics
NPI:1730151945
Name:RAY, RENEE M (PA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:RAY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:321 ARCH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3214
Mailing Address - Country:US
Mailing Address - Phone:814-333-7109
Mailing Address - Fax:814-333-7108
Practice Address - Street 1:321 ARCH STREET STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-333-7109
Practice Address - Fax:814-333-7108
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA000803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103142620Medicaid
PA0077383300001Medicaid
PA117030EMHMedicare PIN