Provider Demographics
NPI:1427089952
Name:POULIN, RONALD F (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:F
Last Name:POULIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-466-1800
Mailing Address - Fax:757-466-2790
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE # 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-466-1800
Practice Address - Fax:757-466-2790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5826403Medicaid
VAC06080Medicare ID - Type Unspecified
VA5826403Medicaid