Provider Demographics
NPI:1306942008
Name:AWAIDA, RONY CAMILLE (MD)
Entity type:Individual
Prefix:
First Name:RONY
Middle Name:CAMILLE
Last Name:AWAIDA
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 1:9225 E MARKET ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5517
Mailing Address - Country:US
Mailing Address - Phone:330-372-7470
Mailing Address - Fax:330-372-7480
Practice Address - Street 1:9225 E MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5517
Practice Address - Country:US
Practice Address - Phone:330-372-7470
Practice Address - Fax:330-372-7480
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39572207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2740501Medicaid
OHAW4225981Medicare PIN
I34096Medicare UPIN