Provider Demographics
NPI:1265468458
Name:BLEDSOE, RALPH DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DANIEL
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 S FRONT ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2010
Mailing Address - Country:US
Mailing Address - Phone:717-988-0000
Mailing Address - Fax:717-782-5716
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-3380
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422588207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA83231OtherGEISINGER-YH
PAP00087656OtherRAILROAD MEDICARE
PA1533716OtherGATEWAY-YH
PA213036OtherUNISON-WMG
PA50067206OtherAMERIHEALTH 65 PA-YH
PA30024864OtherKEYSTONE
PA20069581OtherAMERIHEALTH-WMG
PA50067206OtherCAPITAL BLUE CROSS-YH
PA100819608Medicaid
PA1532050OtherHIGHMARK BLUE SHIELD-YH
PA30024864OtherKEYSTONE
H95987Medicare UPIN
PA1532050OtherHIGHMARK BLUE SHIELD-YH