=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952548067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD LANDAU, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2009
-----------------------------------------------------
Last Update Date | 04/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 MAIN ST
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43912-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-633-3529
-----------------------------------------------------
Fax | 740-633-3574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 337 MAIN ST
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43912-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-633-3529
-----------------------------------------------------
Fax | 740-633-3574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RONALD I LANDAU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 740-633-3529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 25000021
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------