Provider Demographics
NPI:1053591602
Name:RENGO, RENA BURLINGAME (MD)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:BURLINGAME
Last Name:RENGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 INDIGO DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6865
Mailing Address - Country:US
Mailing Address - Phone:912-261-2669
Mailing Address - Fax:
Practice Address - Street 1:203 INDIGO DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6865
Practice Address - Country:US
Practice Address - Phone:912-261-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00705207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC148U6OtherBCBS OF NC
NCP00445423OtherRAILROAD MEDICARE
NC5909325Medicaid
NC5909325Medicaid