Provider Demographics
NPI:1275683443
Name:MUKAMAL, RONALD SASSON (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:SASSON
Last Name:MUKAMAL
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 1:7216 DENBERG ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1006
Mailing Address - Country:US
Mailing Address - Phone:410-302-8848
Mailing Address - Fax:410-602-0409
Practice Address - Street 1:304 REISTERSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-602-0407
Practice Address - Fax:410-602-0409
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044899208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C80657Medicare UPIN