Provider Demographics
NPI:1477580660
Name:KINSEY, RONALD CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CLIFFORD
Last Name:KINSEY
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 1:4512 WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4725
Mailing Address - Country:US
Mailing Address - Phone:301-312-6091
Mailing Address - Fax:301-312-6092
Practice Address - Street 1:23789 GARRETT HWY
Practice Address - Street 2:
Practice Address - City:MC HENRY
Practice Address - State:MD
Practice Address - Zip Code:21541-1338
Practice Address - Country:US
Practice Address - Phone:240-964-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047699174400000X
WV29400207P00000X
MDD47699207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD872044400Medicaid
DC037061800Medicaid
MD76881001OtherBS
DCH9140015OtherBS
DC017858G47Medicare ID - Type Unspecified
G14086Medicare UPIN
DC037061800Medicaid
MDP00704229Medicare PIN