Provider Demographics
NPI:1952380727
Name:ROMAKER, RALPH R (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:R
Last Name:ROMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:RICHARD
Other - Last Name:ROMAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1800 GRANVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1043
Mailing Address - Country:US
Mailing Address - Phone:740-785-4678
Mailing Address - Fax:740-687-1518
Practice Address - Street 1:1800 GRANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1043
Practice Address - Country:US
Practice Address - Phone:740-785-4678
Practice Address - Fax:740-687-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293990Medicaid
OH0293990Medicaid
A75040Medicare UPIN
RO0405412Medicare ID - Type Unspecified
000000008954OtherANTHEM
0101227OtherUNITED HEALTHCARE
4210411OtherAETNA