Provider Demographics
NPI:1508919077
Name:GEMMA, RONALD L (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:GEMMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6978
Practice Address - Country:US
Practice Address - Phone:317-957-9150
Practice Address - Fax:317-957-9965
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000649B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01424314OtherRAIL ROAD PTAN
IN000000668488OtherANTHEM
IN201024840Medicaid
IN000000084479OtherANTHEM
E46560Medicare UPIN
IN266180419Medicare PIN
INP01424314OtherRAIL ROAD PTAN
IN000000668488OtherANTHEM
INM400032193Medicare PIN