1992818686 NPI number — RONALD SCOTT BUCHOLTZ MA, DPT, OCS

Table of content: RONALD SCOTT BUCHOLTZ MA, DPT, OCS (NPI 1992818686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992818686 NPI number — RONALD SCOTT BUCHOLTZ MA, DPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHOLTZ
Provider First Name:
RONALD
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, DPT, OCS
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:
1992818686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 GARFIELD AVE
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-3247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-865-6778
Provider Business Mailing Address Fax Number:
304-865-7400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 GARFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-865-6778
Provider Business Practice Location Address Fax Number:
304-865-7400
Provider Enumeration Date:
08/16/2006

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: 225100000X , with the licence number:  002468 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2608548 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810002649 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00353841 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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