Provider Demographics
NPI:1063520526
Name:MAIN, RONALD HANSEL (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HANSEL
Last Name:MAIN
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 1:2604B EL CAMINO REAL STE 275
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1214
Mailing Address - Country:US
Mailing Address - Phone:442-888-4176
Mailing Address - Fax:
Practice Address - Street 1:2604B EL CAMINO REAL STE 275
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1214
Practice Address - Country:US
Practice Address - Phone:442-888-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094694A207RC0000X
CAG40882207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35485221Medicaid
NM35485221Medicaid
NM343513800Medicare ID - Type UnspecifiedINDIVIDUAL