Provider Demographics
NPI:1295892107
Name:CODARIO, RONALD ANTHONY SR (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANTHONY
Last Name:CODARIO
Suffix:SR
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 1:2511 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4309
Mailing Address - Country:US
Mailing Address - Phone:215-467-3883
Mailing Address - Fax:215-467-2911
Practice Address - Street 1:2511 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4309
Practice Address - Country:US
Practice Address - Phone:215-467-3883
Practice Address - Fax:215-467-2911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015340-E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0055123000OtherBLUE SHIELD PERS CHOICE
PA0055123000OtherPA BLUE SHIELD
PA0076334003OtherAMERICHOICE OF PA
PA1039424OtherKEYSTONE MERCY
PA0076334003OtherAMERICHOICE OF PA
PAB40643Medicare UPIN