MEDICARE: DR. RONALD J AVENIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD018110E	PA

General Provider Information

NPI Number	:	1528048311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD J AVENIA M.D.

Provider Business Mailing Address
First Line	:	410 GLENN AVE
Second Line	:	SUITE 302
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1200
Country	:	US
Telephone Number	:	570-387-0600
Fax Number	:	570-784-0813

Provider Business Practice Location Address
First Line	:	410 GLENN AVE
Second Line	:	SUITE 302
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1200
Country	:	US
Telephone Number	:	570-387-0600
Fax Number	:	570-784-0813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/19/2008

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