Healthcare Provider Details

I. General information

NPI: 1750685038
Provider Name (Legal Business Name): RANON CORTELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2010
Last Update Date: 12/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 WATERLOO RD
JESSUP MD
20794-9783
US

IV. Provider business mailing address

817 HYDE RD
SILVER SPRING MD
20902-3047
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-3400
  • Fax:
Mailing address:
  • Phone: 301-593-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04968
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: