Healthcare Provider Details

I. General information

NPI: 1134114127
Provider Name (Legal Business Name): RONALD WINSTON BEWICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 LEONARD AVE STE 202
WASHINGTON PA
15301-3368
US

IV. Provider business mailing address

95 LEONARD AVE STE 202
WASHINGTON PA
15301-3368
US

V. Phone/Fax

Practice location:
  • Phone: 252-757-2663
  • Fax: 252-317-0829
Mailing address:
  • Phone: 724-206-0610
  • Fax: 724-503-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102827
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: