Provider Demographics
NPI:1326136789
Name:KOFF, RONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:KOFF
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:PO BOX 189
Mailing Address - Street 2:15 SO MAIN ST
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050
Mailing Address - Country:US
Mailing Address - Phone:502-845-7550
Mailing Address - Fax:502-845-5551
Practice Address - Street 1:15 SO MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:KY
Practice Address - Zip Code:40050
Practice Address - Country:US
Practice Address - Phone:502-845-7550
Practice Address - Fax:502-845-5551
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047169OtherANTHEM
KY64167372Medicaid
KY1049483OtherPASSPORT
1017501Medicare ID - Type Unspecified
KY000000047169OtherANTHEM