Michael A Renaldo, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS019414L Issued in PA

Practice address

1521 8TH Ave Ste 101
Bethlehem, PA 18018-1893

Phone

(610) 865-8077

Fax

(610) 865-8112

NPI assigned

Aug 24, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Luke'S Physician Group, Inc.

  • Trauma Surgery Physician
  • Bethlehem, PA
  • NPI 1083789150
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1154314219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 8TH AVE STE 101",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180181893",
            "telephone_number": "610-865-8077",
            "fax_number": "610-865-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 8TH AVE STE 101",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180181893",
            "telephone_number": "610-865-8077",
            "fax_number": "610-865-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENALDO",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS019414L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "01412301",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US HEALTHCARE",
            "identifier": "182033",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "DS019414L",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID #",
            "identifier": "232702929",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUE SHIELD",
            "identifier": "028552",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Remar Behavioral Health Services
• Kirsten Remely
• Chris C Remmel
• Jennifer Brianne Remmen
• Nels Remmen, CRNA
• Renew and Thrive LLC
• Santiago Rengifo, MD
• Chelsea Powlus Renna, PSY.D.
• Michele Renner
• Timothy Renzi, MD

• Oral and Maxillofacial Surgery (Dentist) in Bethlehem, PA
• Providers in Bethlehem, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.