Provider Demographics
NPI:1861835852
Name:GOLAN, RON (MD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:GOLAN
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 1:161 FORT WASHINGTON AVE FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-0114
Mailing Address - Fax:212-305-0116
Practice Address - Street 1:4151 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1110
Practice Address - Country:US
Practice Address - Phone:805-681-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296290208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA168628OtherLICENSE NUMBER