1780651034 NPI number — DR. RONALD MARK LANDESS DPM

Table of content: DR. RONALD MARK LANDESS DPM (NPI 1780651034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780651034 NPI number — DR. RONALD MARK LANDESS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDESS
Provider First Name:
RONALD
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1780651034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 OLD RICHMOND AVE
Provider Second Line Business Mailing Address:
E24
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-282-6576
Provider Business Mailing Address Fax Number:
804-282-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 OLD RICHMOND AVE
Provider Second Line Business Practice Location Address:
E24
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-282-6576
Provider Business Practice Location Address Fax Number:
804-282-5223
Provider Enumeration Date:
03/07/2006

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: 213E00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9301771 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 082667 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 225118 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320871 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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