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General NPI Number Information
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NPI Number | 1780720185
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Entity Type | Individual
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Provider Name | RONALDO S MAYUGA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 5100 AUTH WAY
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City | SUITLAND
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State | MD
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Zip | 20746
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Country | US
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Telephone | 301-702-5000
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Fax | 301-702-5116
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Provider Business Mailing Address
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Address Line | 2101 EAST JEFFERSON STREET KAISER PERMANENTE, PPQA, 6 WEST
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City | ROCKVILLE
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State | MD
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Zip | 20852
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Country | US
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Telephone | 301-816-6660
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Fax | 301-816-6308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD034457
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 0101055799
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | D43667
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License Number State | MD
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