Provider Demographics
NPI:1215922265
Name:RONALD A KRISCH MD PC
Entity type:Organization
Organization Name:RONALD A KRISCH MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:KRISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-432-5444
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:STE 208A
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-432-5444
Mailing Address - Fax:610-432-5440
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:STE 208A
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-432-5444
Practice Address - Fax:610-432-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022249E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02352100OtherCAPITAL BLUE CROSS
PA07823136Medicaid
PAKR131595OtherHIGHMARK BLUE SHIELD
B37671Medicare UPIN
PAKR131595OtherHIGHMARK BLUE SHIELD
B37671Medicare UPIN