Provider Demographics
NPI:1992835722
Name:AQUADRO, RALPH L III (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:L
Last Name:AQUADRO
Suffix:III
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 1:1935 E. GLENN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-321-4989
Mailing Address - Fax:334-501-2223
Practice Address - Street 1:1935 E. GLENN AVE.
Practice Address - Street 2:STE 102
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-321-4989
Practice Address - Fax:334-501-2223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31455208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty