Provider Demographics
NPI:1083652812
Name:RONCO, DOMENICK NICHOLAS (DO)
Entity Type:Individual
Prefix:
First Name:DOMENICK
Middle Name:NICHOLAS
Last Name:RONCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:137 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-7066
Practice Address - Country:US
Practice Address - Phone:570-966-1004
Practice Address - Fax:570-966-3736
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2015-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004260L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006755230001Medicaid
PA0006755230001Medicaid