Provider Demographics
NPI:1902874654
Name:WEBER, RONALD J (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:WEBER
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 1:427 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4220
Mailing Address - Country:US
Mailing Address - Phone:610-688-8807
Mailing Address - Fax:610-688-2970
Practice Address - Street 1:427 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4220
Practice Address - Country:US
Practice Address - Phone:610-688-8807
Practice Address - Fax:610-688-2970
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-020316-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00699454Medicaid
PA00699454Medicaid
PA092858EP0Medicare ID - Type Unspecified