Provider Demographics
NPI:1841397858
Name:INTINI, RONALD S (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:INTINI
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:PO BOX 2079
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-2079
Mailing Address - Country:US
Mailing Address - Phone:919-365-7272
Mailing Address - Fax:919-365-7215
Practice Address - Street 1:2600 NC HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-9319
Practice Address - Country:US
Practice Address - Phone:919-365-7272
Practice Address - Fax:919-365-7215
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891287KMedicaid
C24825Medicare UPIN
2045074Medicare ID - Type Unspecified