Provider Demographics
NPI:1053360784
Name:RENART, PABLO V (MD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:V
Last Name:RENART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6312
Mailing Address - Country:US
Mailing Address - Phone:301-270-2379
Mailing Address - Fax:301-270-2349
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6312
Practice Address - Country:US
Practice Address - Phone:301-270-2379
Practice Address - Fax:301-270-2349
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD23769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23025OtherMAMSI
MD6885PVOtherCAREFIRST MD
MD1468136OtherCIGNA
MD0564517OtherTRICARE/CHAMPUS
MD343494OtherNCPPO
MD4053225OtherAETNA
MD0700340OtherUNITED HEALTHCARE
MD23025OtherMDIPA
MD242110100Medicaid
DC79940001OtherBLUECHOICE DC
MD23025OtherOPTIMUM CHOICE
MD23025OtherALLIANCE PPO
MD343494OtherNCPPO
MD4053225OtherAETNA
MD1468136OtherCIGNA