Provider Demographics
NPI:1639414071
Name:CREAMER, RONALD J
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:CREAMER
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 1:25 LAKE ST GEORGE TER
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:ME
Mailing Address - Zip Code:04949-3132
Mailing Address - Country:US
Mailing Address - Phone:207-589-3128
Mailing Address - Fax:
Practice Address - Street 1:25 LAKE ST GEORGE TER
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:ME
Practice Address - Zip Code:04949-3132
Practice Address - Country:US
Practice Address - Phone:207-589-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker