Provider Demographics
NPI:1871876904
Name:CHIN, RENEE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:CHIN
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 1:114 WOODLAND PARK
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1219
Mailing Address - Country:US
Mailing Address - Phone:860-714-5170
Mailing Address - Fax:
Practice Address - Street 1:114 WOODLAND PARK
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1219
Practice Address - Country:US
Practice Address - Phone:860-714-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-0646813OtherST. FRANCIS HOSPITAL MEDICAL CENTER