Provider Demographics
NPI:1265680938
Name:DERSTINE, RALPH LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:LAWRENCE
Last Name:DERSTINE
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 1:488 HARLEYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438
Mailing Address - Country:US
Mailing Address - Phone:215-256-9445
Mailing Address - Fax:215-256-4857
Practice Address - Street 1:488 HARLEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438
Practice Address - Country:US
Practice Address - Phone:215-256-9445
Practice Address - Fax:215-256-4857
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008043E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine