Provider Demographics
NPI:1114072386
Name:RONALD PEDALINO DO LLC
Entity Type:Organization
Organization Name:RONALD PEDALINO DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PEDALINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-382-4564
Mailing Address - Street 1:7134 COPPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8169
Mailing Address - Country:US
Mailing Address - Phone:937-725-6640
Mailing Address - Fax:
Practice Address - Street 1:7134 COPPERWOOD CT
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8169
Practice Address - Country:US
Practice Address - Phone:937-725-6640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003101208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448519Medicaid
OHA79874Medicare UPIN
OH0448519Medicaid