Provider Demographics
NPI:1689768053
Name:BRONITSKY, RONALD W (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:BRONITSKY
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE
Practice Address - Street 2:PMG SOUTHWEST PULMONARY CRITICAL CARE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-842-5105
Practice Address - Fax:505-842-6209
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM8120207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32300Medicaid
C97518Medicare UPIN
NMNM301248Medicare PIN
NM32300Medicaid