Provider Demographics
NPI:1366444317
Name:WASHINGTON, RONALD A (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1028
Mailing Address - Country:US
Mailing Address - Phone:631-360-3344
Mailing Address - Fax:631-724-8344
Practice Address - Street 1:49 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1028
Practice Address - Country:US
Practice Address - Phone:631-360-3344
Practice Address - Fax:631-724-8344
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003650213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00800275Medicaid
NYT51185Medicare UPIN
NY00800275Medicaid
NYP38931Medicare ID - Type Unspecified