Provider Demographics
NPI:1003850876
Name:BOERSMA, RONALD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:BOERSMA
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 1:310 STERLING DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1718
Mailing Address - Country:US
Mailing Address - Phone:716-677-6800
Mailing Address - Fax:716-712-0159
Practice Address - Street 1:310 STERLING DRIVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1718
Practice Address - Country:US
Practice Address - Phone:716-677-6800
Practice Address - Fax:716-712-0159
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00589886Medicaid
NYP00275983OtherCHS RAILROAD MEDICARE
NYCC9979Medicare ID - Type UnspecifiedCHS MEDICARE
NY00589886Medicaid
NYE15261Medicare ID - Type Unspecified