Provider Demographics
NPI:1225039894
Name:FISCELLA, RONALD BELLINGER (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BELLINGER
Last Name:FISCELLA
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 1:2526 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5016
Mailing Address - Country:US
Mailing Address - Phone:309-281-2860
Mailing Address - Fax:309-281-2869
Practice Address - Street 1:2526 41ST ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5016
Practice Address - Country:US
Practice Address - Phone:309-281-2860
Practice Address - Fax:309-281-2869
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1225039894Medicaid
IL792083065OtherRAILROAD MEDICARE
ILC44665Medicare UPIN
IL200715012Medicare PIN