Healthcare Provider Details

I. General information

NPI: 1790783140
Provider Name (Legal Business Name): RONALD A. MONACK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CLUB LN STE 102
BLAIRSVILLE PA
15717-7957
US

IV. Provider business mailing address

56 CLUB LN STE 102
BLAIRSVILLE PA
15717-7957
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-5203
  • Fax: 724-459-0949
Mailing address:
  • Phone: 724-834-2525
  • Fax: 724-459-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS008970L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: