Provider Demographics
NPI:1194779264
Name:PASTRICK, RONALD LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:PASTRICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 HIGH POINTE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2043
Mailing Address - Country:US
Mailing Address - Phone:513-256-2032
Mailing Address - Fax:513-407-6829
Practice Address - Street 1:7105 HIGH POINTE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2043
Practice Address - Country:US
Practice Address - Phone:513-256-2032
Practice Address - Fax:513-407-6829
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0790345Medicaid
OH0757757Medicaid
OH0757757Medicaid
AL9929672Medicare ID - Type UnspecifiedGROUP
PA0652563Medicare ID - Type UnspecifiedINDIVIDUAL