Provider Demographics
NPI:1558356568
Name:WARNER, RONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1337 HYDE PARK AVE
Mailing Address - Street 2:C/O HYDE PARK MEDICAL CARE
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2713
Mailing Address - Country:US
Mailing Address - Phone:617-364-9880
Mailing Address - Fax:617-361-3663
Practice Address - Street 1:1337 HYDE PARK AVE
Practice Address - Street 2:C/O HYDE PARK MEDICAL CARE
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2713
Practice Address - Country:US
Practice Address - Phone:617-364-9880
Practice Address - Fax:617-361-3663
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-10-09
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Provider Licenses
StateLicense IDTaxonomies
MA081807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401338OtherUNITED HEALTHCARE
65929OtherHARVARD PILGRIM HEALTHCAR
585491OtherAETNA US HEALTHCARE
043235613OtherTAX ID GROUP BILLING NUMB
MA081807OtherTUFTS
110193638OtherPLAMETTO GBA
MAWAJ31905OtherBXBS
0004078OtherNEIGHBORHOOD HEALTH PLAN
MA3141977Medicaid
MAA21039Medicare ID - Type Unspecified
0004078OtherNEIGHBORHOOD HEALTH PLAN
G23487Medicare UPIN