Provider Demographics
NPI:1861411860
Name:BOST, RONALD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:BOST
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 1:50 STONEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-9523
Mailing Address - Country:US
Mailing Address - Phone:570-696-4869
Mailing Address - Fax:570-696-4869
Practice Address - Street 1:50 STONEY BROOK RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-9523
Practice Address - Country:US
Practice Address - Phone:570-696-4869
Practice Address - Fax:570-696-4869
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043240E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
139775Medicare ID - Type Unspecified
B67166Medicare UPIN