Provider Demographics
NPI:1548475155
Name:PASCAL, RONNIE JAMES
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:JAMES
Last Name:PASCAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 POLLY RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9416
Mailing Address - Country:US
Mailing Address - Phone:330-626-0541
Mailing Address - Fax:
Practice Address - Street 1:3144 POLLY RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9416
Practice Address - Country:US
Practice Address - Phone:330-626-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2661463374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2661463Medicaid