Provider Demographics
NPI:1861551236
Name:BUGAOAN, RONALD E (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:BUGAOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:225 WATER ST STE A140
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6248
Mailing Address - Country:US
Mailing Address - Phone:617-817-2833
Mailing Address - Fax:781-987-9286
Practice Address - Street 1:105 WEBSTER ST
Practice Address - Street 2:SUITE #6
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1227
Practice Address - Country:US
Practice Address - Phone:781-878-8200
Practice Address - Fax:781-878-5538
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2303442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA215472Medicaid
MA215472Medicaid