Provider Demographics
NPI:1861485849
Name:IGNACIO, RENANTE F (MD)
Entity type:Individual
Prefix:
First Name:RENANTE
Middle Name:F
Last Name:IGNACIO
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 1:101 W UTICA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3165
Mailing Address - Country:US
Mailing Address - Phone:315-216-4641
Mailing Address - Fax:315-216-6070
Practice Address - Street 1:101 W UTICA ST
Practice Address - Street 2:SUITE C
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3165
Practice Address - Country:US
Practice Address - Phone:315-216-4641
Practice Address - Fax:315-216-6070
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY246837207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02355746Medicaid
NY02355746Medicaid
H48502Medicare UPIN