Provider Demographics
NPI:1063472777
Name:SMITH, RONALD K (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5126 ROUTE 30
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2126
Mailing Address - Country:US
Mailing Address - Phone:724-836-3028
Mailing Address - Fax:724-836-3029
Practice Address - Street 1:5126 ROUTE 30
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7835
Practice Address - Country:US
Practice Address - Phone:724-836-3028
Practice Address - Fax:724-836-3029
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005252L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009875850001Medicaid
PA0009875850001Medicaid
PA142374Medicare ID - Type Unspecified