Provider Demographics
NPI:1578295606
Name:RUNYON, RONALD DAVID
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:RUNYON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 THACKER HOLW
Mailing Address - Street 2:
Mailing Address - City:EDGARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25672-7014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1795 THACKER HOLW
Practice Address - Street 2:
Practice Address - City:EDGARTON
Practice Address - State:WV
Practice Address - Zip Code:25672-7014
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant