Provider Demographics
NPI:1104228261
Name:COSSIN, RONALD
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:COSSIN
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 1:3945 HILLMAN RD E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4170
Mailing Address - Country:US
Mailing Address - Phone:614-806-0177
Mailing Address - Fax:
Practice Address - Street 1:3945 HILLMAN RD E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4170
Practice Address - Country:US
Practice Address - Phone:614-806-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3157220Medicaid