Provider Demographics
NPI:1275670499
Name:VANDEGRIFF, RONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:VANDEGRIFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PENNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-8821
Mailing Address - Country:US
Mailing Address - Phone:610-286-0466
Mailing Address - Fax:
Practice Address - Street 1:23 PENNWOOD DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-8821
Practice Address - Country:US
Practice Address - Phone:610-286-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010255-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH49813Medicare UPIN