Provider Demographics
NPI:1598726028
Name:RITENOUR, PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:RITENOUR
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 1:43 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1303
Mailing Address - Country:US
Mailing Address - Phone:419-571-5290
Mailing Address - Fax:419-522-0998
Practice Address - Street 1:43 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1303
Practice Address - Country:US
Practice Address - Phone:419-571-5290
Practice Address - Fax:419-522-0998
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OH34.006501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2075276Medicaid
OH4243534Medicare PIN
OH2075276Medicaid
OHG45907Medicare UPIN