Healthcare Provider Details

I. General information

NPI: 1447222039
Provider Name (Legal Business Name): RONALD W SIMONSEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 BIRD AVE
WARREN PA
16365
US

IV. Provider business mailing address

341 BIRD AVE
WARREN PA
16365
US

V. Phone/Fax

Practice location:
  • Phone: 814-723-6858
  • Fax:
Mailing address:
  • Phone: 814-723-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD008430E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD008430E
License Number StatePA

VIII. Authorized Official

Name: RONALD WILLIAM SIMONSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 814-723-6858