Provider Demographics
NPI:1639128788
Name:RAMEY, RUSSELL L (MD)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:L
Last Name:RAMEY
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 1:1330 MERCY DRIVE NW
Mailing Address - Street 2:SUITE 222
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2626
Mailing Address - Country:US
Mailing Address - Phone:330-489-1451
Mailing Address - Fax:330-489-1364
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:SUITE 222
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-489-1451
Practice Address - Fax:330-489-1364
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063217174400000X
OH35-06-3217174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRA0775012Medicare UPIN