Provider Demographics
NPI:1598794968
Name:LUBER, RONALD S
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:LUBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1003
Mailing Address - Country:US
Mailing Address - Phone:215-942-2850
Mailing Address - Fax:
Practice Address - Street 1:778 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1003
Practice Address - Country:US
Practice Address - Phone:215-942-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002905L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00616282Medicaid
PAB29767Medicare UPIN
PA00616282Medicaid