Provider Demographics
NPI:1376557231
Name:MANIS, RONAL D JR (MD)
Entity Type:Individual
Prefix:
First Name:RONAL
Middle Name:D
Last Name:MANIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:BLDG B 3RD FL
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:1752 W HIGH ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9325
Practice Address - Country:US
Practice Address - Phone:937-773-3737
Practice Address - Fax:937-440-4250
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-043967207RI0200X
OH35.043967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0583751Medicaid
OH0583751Medicaid
OH054568Medicare PIN