Healthcare Provider Details

I. General information

NPI: 1295539211
Provider Name (Legal Business Name): MAKSIM ALEKSANDROVICH RIBALKO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 BEAMAN ST
CLINTON NC
28328-2603
US

IV. Provider business mailing address

5041 BUFFALO RD
ERIE PA
16510-2305
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-1551
  • Fax:
Mailing address:
  • Phone: 585-478-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL25-0495
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: