Provider Demographics
NPI:1932194958
Name:ENDO, RONALD N (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:N
Last Name:ENDO
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 1:847 EASTON RD
Mailing Address - Street 2:STE 2500
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2906
Mailing Address - Country:US
Mailing Address - Phone:215-918-5775
Mailing Address - Fax:218-918-5776
Practice Address - Street 1:847 EASTON RD
Practice Address - Street 2:STE 2500
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2906
Practice Address - Country:US
Practice Address - Phone:215-918-5775
Practice Address - Fax:218-918-5776
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039414E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1162148Medicaid
PA151126Medicare ID - Type Unspecified
E12928Medicare UPIN