Provider Demographics
NPI:1457332785
Name:CROCK, RONALD D (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:CROCK
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 1:7072 MEARS GATE DR NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8850
Mailing Address - Country:US
Mailing Address - Phone:330-966-1319
Mailing Address - Fax:330-966-1321
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066830C207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157366OtherGROUP MEDICAID - MPCC
OH1376559799OtherGROUP NPI
1902827876OtherGROUP NPI - MPCC
OH0142081Medicaid
2157320OtherGROUP MEDICAID
OHME9303389OtherGROUP MEDICARE - MPCC
OHF97120Medicare UPIN
OHCR0777661Medicare ID - Type Unspecified
OHCR0777663Medicare PIN