Provider Demographics
NPI:1932265386
Name:BALLEK, RONALD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EDWARD
Last Name:BALLEK
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 1:1379 HELLER DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2715
Mailing Address - Country:US
Mailing Address - Phone:215-321-7701
Mailing Address - Fax:215-321-7704
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 404A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:215-321-7701
Practice Address - Fax:215-321-7704
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015264E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC27733Medicare UPIN
PABA022212Medicare ID - Type Unspecified