Provider Demographics
NPI:1295850105
Name:THESEE, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:THESEE
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 1:293 GENESEE ST.
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3804
Mailing Address - Country:US
Mailing Address - Phone:315-272-2600
Mailing Address - Fax:315-733-8169
Practice Address - Street 1:195 - 199 W. DOMINICK ST.
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5855
Practice Address - Country:US
Practice Address - Phone:315-272-2730
Practice Address - Fax:315-337-0675
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP273422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP27342Medicaid
NYOTH000Medicare UPIN