Provider Demographics
NPI:1851351910
Name:MATTSON, RONALD J (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:MATTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:830 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-436-6529
Mailing Address - Fax:610-436-6479
Practice Address - Street 1:830 OLD LANCASTER RD.
Practice Address - Street 2:SUITE 306
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-527-1185
Practice Address - Fax:610-527-1940
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD013533E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013332660002Medicaid
PA0006386640003Medicaid
PA0006386640003Medicaid
084901M10Medicare Oscar/Certification