Provider Demographics
NPI:1568417764
Name:PRESTON, RONALD ALLYN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ALLYN
Last Name:PRESTON
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:PO BOX 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-514-6685
Mailing Address - Fax:252-514-2745
Practice Address - Street 1:1020 MEDICAL PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5248
Practice Address - Country:US
Practice Address - Phone:252-514-6685
Practice Address - Fax:252-514-2745
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC69165OtherBCBS OF NC
NC7969165Medicaid
NC209710DMedicare PIN
NC110158096Medicare PIN
NC209710EMedicare PIN
NC7969165Medicaid