Provider Demographics
NPI:1548319619
Name:RONALD A SHUBERT MD INC
Entity type:Organization
Organization Name:RONALD A SHUBERT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-453-3099
Mailing Address - Street 1:3501 TUSCARAWAS ST W
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5640
Mailing Address - Country:US
Mailing Address - Phone:330-453-3099
Mailing Address - Fax:330-453-3240
Practice Address - Street 1:3501 TUSCARAWAS ST W
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-5640
Practice Address - Country:US
Practice Address - Phone:330-453-3099
Practice Address - Fax:330-453-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-028483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223663Medicaid
OH9387741Medicare PIN
OHA74029Medicare UPIN