Provider Demographics
NPI:1922083708
Name:CERCONE, RONALD G (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:CERCONE
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 1:3000 STONEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8317
Mailing Address - Country:US
Mailing Address - Phone:724-934-5520
Mailing Address - Fax:724-934-5533
Practice Address - Street 1:3000 STONEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8317
Practice Address - Country:US
Practice Address - Phone:724-934-5520
Practice Address - Fax:724-934-5533
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035576E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102603OtherUPMC
PA427840OtherHIGHMARK BLUE SHIELD
PA13566OtherELDER HEALTH CARE
PA1495669004OtherCIGNA
PA485614OtherAETNA
PA01050606Medicare ID - Type Unspecified
PA427840LMCMedicare ID - Type Unspecified
PA485614OtherAETNA