Provider Demographics
NPI:1508818311
Name:AQUINO, RAMON JONGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:JONGO
Last Name:AQUINO
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 1:351 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4144
Mailing Address - Country:US
Mailing Address - Phone:931-552-4495
Mailing Address - Fax:931-552-1944
Practice Address - Street 1:351 DOVER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4144
Practice Address - Country:US
Practice Address - Phone:931-552-4495
Practice Address - Fax:931-552-1944
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 15005208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3159740Medicaid
TNMD 15005OtherSTATE LICENSE NUMBER
TNMD 15005OtherSTATE LICENSE NUMBER
TNBA2233928OtherDEA NUMBER
TN3159740Medicaid