Provider Demographics
NPI:1336153303
Name:ST LOUIS, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:ST LOUIS
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 1:1333A NORTH AVE
Mailing Address - Street 2:P.M.B.709
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2120
Mailing Address - Country:US
Mailing Address - Phone:718-324-6365
Mailing Address - Fax:718-881-5700
Practice Address - Street 1:3327 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2801
Practice Address - Country:US
Practice Address - Phone:718-324-6365
Practice Address - Fax:718-881-5700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39K682OtherBC BS PROVIDER NUMBER
NY432899N1OtherCIGNA PROVIDER NUMBER
NY01569566Medicaid
NY1782397OtherUNITED HEALTHCARE
NY0H2808OtherHEALTHNET PROVIDER NUMBER
NY7886075OtherAETNA PPO
NY3208825OtherAETNA-HMO PROVIDER NUMBER
NY13406262101Other1199 NAT'L BENEFIT FUND
NYP2486790OtherOXFORD PROVIDER NUMBER
NY0401897OtherUNITED HEALTHCARE MEDICAR
NY173155-C14OtherHEALTHFIRST PROVIDER #
NY0H2808OtherHEALTHNET PROVIDER NUMBER
NY39K682Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER