Provider Demographics
NPI:1598753857
Name:BEVILACQUA, RONALD FRANCIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANCIS
Last Name:BEVILACQUA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 YORK ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2007
Mailing Address - Country:US
Mailing Address - Phone:717-334-8178
Mailing Address - Fax:
Practice Address - Street 1:418 YORK ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2007
Practice Address - Country:US
Practice Address - Phone:717-334-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001989L213E00000X
MD00943213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01522101OtherBLUE CROSS
PA1407821Medicaid
PABE89486Medicare ID - Type Unspecified
MD737RMedicare ID - Type Unspecified
PA1407821Medicaid