Provider Demographics
NPI:1053368555
Name:DR. RONALD SMALL, D.P.M., P.C.
Entity type:Organization
Organization Name:DR. RONALD SMALL, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-924-2521
Mailing Address - Street 1:104 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1027
Mailing Address - Country:US
Mailing Address - Phone:215-924-2521
Mailing Address - Fax:215-924-2367
Practice Address - Street 1:104 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1027
Practice Address - Country:US
Practice Address - Phone:215-924-2521
Practice Address - Fax:215-924-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003322L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011782190007Medicaid
PAT90995Medicare UPIN
PA0011782190007Medicaid
PADG6865Medicare PIN