Provider Demographics
NPI:1073526356
Name:EMERSON, RONALD PAUL JR (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:EMERSON
Suffix:JR
Gender:M
Credentials:MD, FACC
Other - Prefix:
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Mailing Address - Street 1:3065 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1239
Mailing Address - Country:US
Mailing Address - Phone:716-677-5866
Mailing Address - Fax:716-677-5868
Practice Address - Street 1:3065 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1239
Practice Address - Country:US
Practice Address - Phone:716-677-5866
Practice Address - Fax:716-677-5868
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183508-1207RC0000X
WI32724207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01690913Medicaid
NY2109974OtherINDEPENDENT HEALTH
NY00052489003OtherBLUE CROSS
NY00010311201OtherUNIVERA
NYE88912Medicare UPIN
NY01690913Medicaid
NY00052489003OtherBLUE CROSS