Provider Demographics
NPI:1861470213
Name:SCHOUTEN, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:SCHOUTEN
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 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-5195
Mailing Address - Fax:617-724-2808
Practice Address - Street 1:15 PARKMAN STREET WAC 805
Practice Address - Street 2:PSYCHIATRY OUTPATIENT REFERRAL SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-5195
Practice Address - Fax:617-724-2808
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA571512084F0202X
NYS235135-12084P0800X
CAG716982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06126OtherBCBS MA
MA057151OtherTUFTS HEALTH PLAN
MA3024954Medicaid
MAJ06126Medicare ID - Type Unspecified
MA3024954Medicaid