Provider Demographics
NPI:1134114127
Name:BEWICK, RONALD WINSTON (PA-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WINSTON
Last Name:BEWICK
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 1:95 LEONARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-206-0610
Mailing Address - Fax:724-503-4156
Practice Address - Street 1:95 LEONARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:252-757-2663
Practice Address - Fax:252-317-0829
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970011661OtherRAILROAD MEDICARE
1274070001OtherDME MAC JURISDICTION C
1274070001OtherDME MAC JURISDICTION C
S89563Medicare UPIN