Provider Demographics
NPI:1649389651
Name:MARASCALCO, RONALD F (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:F
Last Name:MARASCALCO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 GLENDALE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4402
Mailing Address - Country:US
Mailing Address - Phone:800-243-0566
Mailing Address - Fax:800-243-0566
Practice Address - Street 1:1806 GLENDALE DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4402
Practice Address - Country:US
Practice Address - Phone:800-243-0566
Practice Address - Fax:252-243-1347
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00908363A00000X
MSPA002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS587607142OtherBCBS
NCNCL847BOtherMEDICARE
NCNCL847AMedicare PIN
MS070009293Medicare PIN