Provider Demographics
NPI:1871584433
Name:ANSINELLI, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:ANSINELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-324-4745
Mailing Address - Fax:606-324-4941
Practice Address - Street 1:2483 HIGHWAY 644
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9242
Practice Address - Country:US
Practice Address - Phone:606-638-9954
Practice Address - Fax:606-638-3595
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37822207RC0000X, 207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000318335OtherANTHEM BCBS
OH0676522Medicaid
P00065868OtherRAILROAD MEDICARE
KY64071392Medicaid
WV000023970OtherMT STATE BCBS
WV0085510000Medicaid
WV0639896Medicare PIN
OH00680114Medicare PIN
WV0639895Medicare PIN
KY00652892Medicare PIN
OH0676522Medicaid
KYK124360Medicare PIN
WV000023970OtherMT STATE BCBS
WV0085510000Medicaid
OH4252991Medicare PIN
KY00788007Medicare PIN