Basic Information
| Provider Information | |||||||||
| NPI: | 1740209006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIDGEWAY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2591 MIAMISBURG CENTERVILLE RD | ||||||||
| Address2: | STE 302 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454593706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374337622 | ||||||||
| FaxNumber: | 9374337656 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453731337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374404800 | ||||||||
| FaxNumber: | 9374404381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35062021 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208D00000X | 35062021 | OH | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | H407582 | 01 | OH | MEDICARE PTAN | OTHER | 0929231 | 05 | OH | MEDICAID |