1588779813 NPI number — LEE-ELLEN T RONIS CCC-A

Table of content: LEE-ELLEN T RONIS CCC-A (NPI 1588779813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588779813 NPI number — LEE-ELLEN T RONIS CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RONIS
Provider First Name:
LEE-ELLEN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588779813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11329 MARCLIFF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-571-2175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 LANDMARK DR STE 808
Provider Second Line Business Practice Location Address:
GLEN BURNIE OUTPATIENT CLINC
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-4983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-590-4140
Provider Business Practice Location Address Fax Number:
410-590-4159
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  00468 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com