Provider Demographics
NPI:1184665325
Name:FALK, RONALD (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:FALK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BURNET AVE
Mailing Address - Street 2:1 RIDGEWAY
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-9009
Mailing Address - Fax:513-585-9374
Practice Address - Street 1:151 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1015
Practice Address - Country:US
Practice Address - Phone:513-948-2639
Practice Address - Fax:513-948-2516
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95001954Medicaid
KY95001954Medicaid
OHP00379575Medicare PIN
OHFAPA15962Medicare PIN