Basic Information
Provider Information
NPI: 1750329041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKINNEY
FirstName: RENEE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherLastName:  
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OtherLastNameType:  
Mailing Information
Address1: 291 INDEPENDENCE DR
Address2: INTERNAL MEDICINE
City: CHESTNUT HILL
State: MA
PostalCode: 024673628
CountryCode: US
TelephoneNumber: 6175416520
FaxNumber: 6175416444
Practice Location
Address1: 291 INDEPENDENCE DR
Address2: INTERNAL MEDICINE
City: CHESTNUT HILL
State: MA
PostalCode: 024673628
CountryCode: US
TelephoneNumber: 6175416520
FaxNumber: 6175416444
Other Information
ProviderEnumerationDate: 06/02/2006
LastUpdateDate: 02/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X217369MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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