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NPI Code Detail

MEDICARE: RONALD MANSOLO MD

MEDICARE: RONALD MANSOLO MD
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
1207Q00000XFamily Medicine PhysicianK0519TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3080123157OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18A8900OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871586933
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD MANSOLO MD
Provider Business Mailing Address
First Line : 902 CRYSTAL FALLS PKWY
Second Line :
City : LEANDER
State : TX
Zip : 78641-3646
Country : US
Telephone Number : 512-259-2222
Fax Number : 512-259-2290
Provider Business Practice Location Address
First Line : 902 CRYSTAL FALLS PKWY
Second Line :
City : LEANDER
State : TX
Zip : 78641-3646
Country : US
Telephone Number : 512-259-2222
Fax Number : 512-259-2290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 03/11/2011

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902 CRYSTAL FALLS PKWY
LEANDER, TX
78641-3646
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902 CRYSTAL FALLS PKWY , SUITE 1
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Practice Fax: 512-259-1433
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Practice Location Address:
902 CRYSTAL FALLS PKWY
LEANDER, TX
78641-3646
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902 CRYSTAL FALLS PKWY
LEANDER, TX
78641-3646
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1255530549 — DR. MARIAELISA GRAFF PHD, RD
Practice Location Address:
902 CRYSTAL FALLS PKWY
LEANDER, TX
78641-3646
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Directions to “ RONALD MANSOLO MD” Practice Location

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