Provider Demographics
NPI:1518973833
Name:BALDERACH, RONALD R (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
Last Name:BALDERACH
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 1:631 N BROAD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4603
Mailing Address - Country:US
Mailing Address - Phone:724-450-7196
Mailing Address - Fax:724-450-7179
Practice Address - Street 1:631 N BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4603
Practice Address - Country:US
Practice Address - Phone:724-450-7196
Practice Address - Fax:724-450-7179
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-016672-E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005932120008Medicaid
PA0005932120008Medicaid
PA113843Medicare ID - Type Unspecified
PA0005932120003Medicaid