Provider Demographics
NPI:1780651034
Name:LANDESS, RONALD MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARK
Last Name:LANDESS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:5700 OLD RICHMOND AVE
Mailing Address - Street 2:E24
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-282-6576
Mailing Address - Fax:804-282-5223
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:E24
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-6576
Practice Address - Fax:804-282-5223
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9301771Medicaid
VA082667OtherANTHEM BC BS
VA225118OtherMAMSI
VA320871OtherANTHEM BC BS
VA082667OtherANTHEM BC BS