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NPI Code Detail

MEDICARE: RICKY D ST ONGE, MD LLC

MEDICARE: RICKY D ST ONGE, MD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center35-066328OH

General Provider Information

NPI Number : 1023372448
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICKY D ST ONGE, MD LLC
Provider Business Mailing Address
First Line : 1255 N HAMILTON RD # 216
Second Line :
City : GAHANNA
State : OH
Zip : 43230-6785
Country : US
Telephone Number : 740-645-3893
Fax Number :
Provider Business Practice Location Address
First Line : 5910 CLEVELAND AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43231-6881
Country : US
Telephone Number : 614-882-4343
Fax Number : 614-882-4664
Authorized Official
Title or Position : SOLE MEMBER
Name : DR. RICKY DONALD ST ONGE
Credential : MD
Telephone Number : 740-645-3893
Provider Enumeration Date : 06/29/2012
Last Update Date : 11/12/2014

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