Provider Demographics
NPI:1235114174
Name:ISON, RODNEY K (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:K
Last Name:ISON
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 1:944 CHERRY ST E
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8669
Mailing Address - Country:US
Mailing Address - Phone:330-854-4574
Mailing Address - Fax:330-854-0829
Practice Address - Street 1:944 CHERRY ST E
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8669
Practice Address - Country:US
Practice Address - Phone:330-854-4574
Practice Address - Fax:330-854-0829
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050685I207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH010034845OtherRAILROAD MEDICARE
OH0569022Medicaid
OH010034845OtherRAILROAD MEDICARE
OH0569022Medicaid