Provider Demographics
NPI:1740231349
Name:RONAN, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:RONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:36 BARBARY CIR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3828
Mailing Address - Country:US
Mailing Address - Phone:617-770-0415
Mailing Address - Fax:
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-997-1515
Practice Address - Fax:508-961-5303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2136402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2013606Medicaid
H89591Medicare UPIN
MA2013606Medicaid