Provider Demographics
NPI:1528048311
Name:AVENIA, RONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:AVENIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:JOSEPH
Other - Last Name:AVENIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:410 GLENN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1200
Mailing Address - Country:US
Mailing Address - Phone:570-387-0600
Mailing Address - Fax:570-784-0813
Practice Address - Street 1:410 GLENN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1200
Practice Address - Country:US
Practice Address - Phone:570-387-0600
Practice Address - Fax:570-784-0813
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018110E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0792450001Medicare NSC
C29820Medicare UPIN
PAAV97281Medicare ID - Type Unspecified