| Doctor Name: | MR. RONALD D DISTLER |
| NPI Number: | 1114081924 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNP |
| License Number: | R136284 |
| Business Practice Address: | 6918 Ridge Rd Rosedale, MD - 212373854 |
| Business Phone Number: | 4434421568 |
| Business Fax Number: | 4434421569 |
| Mailing Address: | 6918 Ridge Rd, ROSEDALE |
| State: | MD |
| Postal Code: | 212373854 |
| Phone Number: | 4434421568 |
| Fax Number: | 4434421569 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 08/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | R136284 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |