Provider Demographics
NPI:1225160443
Name:DAVID, RONALD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-673-9600
Mailing Address - Fax:804-673-8021
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 700
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-673-9600
Practice Address - Fax:804-673-8021
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6131875Medicaid
VA012886OtherANTHEM
VA012886OtherANTHEM
VAB10238Medicare UPIN