Provider Demographics
NPI:1760494058
Name:NORMAN, RONALD WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
Last Name:NORMAN
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 1:120 ACADIA CT APT 12
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7073
Mailing Address - Country:US
Mailing Address - Phone:609-217-0383
Mailing Address - Fax:888-946-7658
Practice Address - Street 1:120 ACADIA CT APT 12
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7073
Practice Address - Country:US
Practice Address - Phone:609-217-0383
Practice Address - Fax:888-946-7658
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00054800363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP16124Medicare UPIN
DE00B457S50Medicare ID - Type UnspecifiedMC INDIVIDUAL #