| Renaissance Health Medical | |
|
176 Thomas Johnson Dr Ste 203 Frederick MD 21702-4535 | |
| (240) 315-4541 | |
| (240) 844-5577 |
| Full Name | Renaissance Health Medical |
|---|---|
| Speciality | General Practice |
| Location | 176 Thomas Johnson Dr Ste 203, Frederick, Maryland |
| Authorized Official Name and Position | Craig Lamar Cheeks Washington (PHYSICIAN OWNER) |
| Authorized Official Contact | 2403154541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Health Medical Po Box 4221 Frederick MD 21705-4221 Ph: (240) 315-4541 | Renaissance Health Medical 176 Thomas Johnson Dr Ste 203 Frederick MD 21702-4535 Ph: (240) 315-4541 |
| NPI Number | 1790671329 |
|---|---|
| Provider Enumeration Date | 06/18/2025 |
| Last Update Date | 09/15/2025 |
| Certification Date | 09/15/2025 |
| Medicare PECOS PAC ID | 5698279321 |
|---|---|
| Medicare Enrollment ID | O20250917000449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790671329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| Provider Name | Craig Lamar Cheeks Washington |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1043731946 PECOS PAC ID: 9638586647 Enrollment ID: I20250917000566 |
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