Provider Demographics
NPI:1417030560
Name:MACEYKO, RONALD FRANK (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:FRANK
Last Name:MACEYKO
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 1:4815 LIBERTY AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-784-1606
Mailing Address - Fax:412-784-8225
Practice Address - Street 1:4815 LIBERTY AVE STE 250
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-784-1606
Practice Address - Fax:412-784-8225
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046336L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF26066Medicare UPIN
PA720472Medicare PIN