Provider Demographics
NPI:1174523641
Name:DELACRUZ, RENATO F (MD)
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:F
Last Name:DELACRUZ
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:PO BOX 6230
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:304-242-7106
Mailing Address - Fax:304-242-7106
Practice Address - Street 1:135 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1583
Practice Address - Country:US
Practice Address - Phone:740-296-5702
Practice Address - Fax:740-296-5705
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0079563000Medicaid
OH0822533Medicaid
OHDG5378OtherGROUP RR MEDICARE
110248353OtherRR MEDICARE
110248353OtherRR MEDICARE
WV0079563000Medicaid
OHDG5378OtherGROUP RR MEDICARE
OHE75594Medicare UPIN