Provider Demographics
NPI:1790775419
Name:RANSOM, RICHARD A (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:RANSOM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620A N WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9461
Mailing Address - Country:US
Mailing Address - Phone:330-364-7546
Mailing Address - Fax:330-364-3720
Practice Address - Street 1:2620A N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9461
Practice Address - Country:US
Practice Address - Phone:330-364-7546
Practice Address - Fax:330-364-3720
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0253587Medicaid
OHRA0376718Medicare ID - Type Unspecified
T80380Medicare UPIN
OH0253587Medicaid