=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215922265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD A KRISCH MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2005
-----------------------------------------------------
Last Update Date | 07/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 S CEDAR CREST BLVD STE 208A
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-432-5444
-----------------------------------------------------
Fax | 610-432-5440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1251 S CEDAR CREST BLVD STE 208A
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-432-5444
-----------------------------------------------------
Fax | 610-432-5440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD AVERY KRISCH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-432-5444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD022249E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------