Healthcare Provider Details

I. General information

NPI: 1992726590
Provider Name (Legal Business Name): RONALD BANN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

6062 SAINT ANDREWS WAY
RAVENNA OH
44266-7739
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1024454
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number50000636
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: