Provider Demographics
NPI:1154353316
Name:GOPPOLD, RONALD WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
Last Name:GOPPOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:WILLIAM
Other - Last Name:GOPPOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:95 ALMSHOUSE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954
Mailing Address - Country:US
Mailing Address - Phone:215-357-5760
Mailing Address - Fax:215-537-5731
Practice Address - Street 1:95 ALMSHOUSE RD
Practice Address - Street 2:STE 103
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954
Practice Address - Country:US
Practice Address - Phone:215-357-5760
Practice Address - Fax:215-357-5731
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018778E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
025661Medicare ID - Type Unspecified
B33539Medicare UPIN