Provider Demographics
NPI:1871917542
Name:RONALD R. MARSH, M.D.,PLLC
Entity type:Organization
Organization Name:RONALD R. MARSH, M.D.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-843-6914
Mailing Address - Street 1:119 HOLLAND CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7550
Mailing Address - Country:US
Mailing Address - Phone:518-843-6914
Mailing Address - Fax:518-843-6915
Practice Address - Street 1:119 HOLLAND CIRCLE DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7550
Practice Address - Country:US
Practice Address - Phone:518-843-6914
Practice Address - Fax:518-843-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01248571Medicaid
NY01248571Medicaid