Provider Demographics
NPI:1730414293
Name:RENZI, PAULA M (DO)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:M
Last Name:RENZI
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 1:819 WORCESTER ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1056
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:819 WORCESTER ST STE 3
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1056
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:413-543-7962
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055122207R00000X
RIDO00865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2007860Medicaid
WA2007860Medicaid