Provider Demographics
NPI:1245252717
Name:WASHBURN, RONALD GLENN (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GLENN
Last Name:WASHBURN
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:MEDICAL CENTER BLVD DEPARTMENT OF MEDICINE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2700
Mailing Address - Fax:336-716-0382
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-4228
Practice Address - Country:US
Practice Address - Phone:336-716-2700
Practice Address - Fax:336-716-0382
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14287R207RI0200X
NC26613207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1138631Medicaid
LA4E719F600Medicare ID - Type Unspecified
LA1138631Medicaid