Provider Demographics
NPI:1639163371
Name:TRESCOT, RONALD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWARD
Last Name:TRESCOT
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 3233
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6771
Mailing Address - Country:US
Mailing Address - Phone:229-985-2198
Mailing Address - Fax:229-891-3250
Practice Address - Street 1:1 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6771
Practice Address - Country:US
Practice Address - Phone:229-985-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041233207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160054545OtherRAILROAD MEDICARE
30020595OtherKEYSTONE MERCY HEALTHPLAN
52754585002OtherSTATE MERIT
52754585002OtherBLUE CROSS BLUE SHIELD
0700884OtherUNITED HEALTHCARE
GA00852992BMedicaid
GA16BDVCZMedicare ID - Type Unspecified
160054545OtherRAILROAD MEDICARE