Provider Demographics
NPI:1760498539
Name:KLARE, RONALD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:KLARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1906
Mailing Address - Country:US
Mailing Address - Phone:860-315-9026
Mailing Address - Fax:860-315-9142
Practice Address - Street 1:24 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1906
Practice Address - Country:US
Practice Address - Phone:860-315-9026
Practice Address - Fax:860-315-9142
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20041207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10020041CT02OtherANTHEM BCBS
CT1200419Medicaid
051161OtherHEALTHNET
CT110004592Medicare ID - Type Unspecified
051161OtherHEALTHNET
CT10020041CT02OtherANTHEM BCBS