Provider Demographics
NPI:1801182738
Name:SUPRENANT, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SUPRENANT
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 1:4000 MIAMISBURG-CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342
Mailing Address - Country:US
Mailing Address - Phone:513-429-8974
Mailing Address - Fax:937-439-3786
Practice Address - Street 1:4000 MIAMISBURG-CENTERVILLE ROAD
Practice Address - Street 2:SUITE 450
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:513-429-8974
Practice Address - Fax:937-439-3786
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.075586207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine