Provider Demographics
NPI:1336103803
Name:DOUGLAS, RONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:49 PLAISTOW RD
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2854
Practice Address - Country:US
Practice Address - Phone:603-371-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH16901207Q00000X
MA254851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH20661Medicare UPIN
VA019106P95 - C03895Medicare PIN