Provider Demographics
NPI:1861454571
Name:GRENKO, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:GRENKO
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048891L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000187809OtherUNISON
PA1512074OtherGATEWAY
PA50060185OtherCAPITAL BLUE CROSS AND KEYSTONE HEALTH PLAN CENTRAL
PA1527859OtherAETNA HMO
PA20050765OtherAMERIHEALTH MERCY
PA000416656OtherHIGHMARK BLUE SHIELD
PA001394250 0008Medicaid
PA0206056000OtherINDEPENDENCE BLUE CROSS
PA21676OtherGEISINGER HEALTH PLAN
PA4299878OtherAETNA NON-HMO
PAP00351049OtherRR MEDICARE
PA1527859OtherAETNA HMO
PA21676OtherGEISINGER HEALTH PLAN