Provider Demographics
NPI:1194715979
Name:WASSERMAN, RONALD E (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:WASSERMAN
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 1:421 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:450 W CHEW ST
Practice Address - Street 2:SIGAL CENTER 2ND FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3434
Practice Address - Country:US
Practice Address - Phone:610-776-5491
Practice Address - Fax:610-606-4432
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015042E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0040483000OtherIBC
PA0007104260009Medicaid
105391OtherHIGHMARK BLUE SHIELD
20040942OtherAMERIHEALTH MERCY
50050305OtherCBC
PAP00282714Medicare PIN
PA105391HR2Medicare PIN
105391OtherHIGHMARK BLUE SHIELD