Provider Demographics
NPI:1932219367
Name:MARSH, RONALD ROBERT (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ROBERT
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HOLLAND CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7550
Mailing Address - Country:US
Mailing Address - Phone:518-843-6914
Mailing Address - Fax:518-843-6915
Practice Address - Street 1:119 HOLLAND CIRCLE DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7550
Practice Address - Country:US
Practice Address - Phone:518-843-6914
Practice Address - Fax:518-843-6915
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01248571Medicaid
NYJ400157816Medicare PIN
NYE80188Medicare UPIN
NY52619BMedicare PIN