Provider Demographics
NPI:1346224177
Name:WISNESKI, RONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:WISNESKI
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 1:701 SAVANNAH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1550
Mailing Address - Country:US
Mailing Address - Phone:302-645-2805
Mailing Address - Fax:302-645-1164
Practice Address - Street 1:701 SAVANNAH RD
Practice Address - Street 2:SUITE B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1550
Practice Address - Country:US
Practice Address - Phone:302-645-2805
Practice Address - Fax:302-645-1164
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89533207X00000X
OH35095773207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3098213Medicaid
FLB41115Medicare UPIN
OH4296701Medicare PIN