Provider Demographics
NPI:1154309797
Name:ROBERTS, RONALD E (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713189
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-3189
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:440-777-6940
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-224-6420
Practice Address - Fax:614-224-6423
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-000066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant