Provider Demographics
NPI:1871772301
Name:BLANCK, RONALD RAY (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAY
Last Name:BLANCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1613 BAY ST
Mailing Address - Street 2:
Mailing Address - City:FENWICK ISLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19944-4506
Mailing Address - Country:US
Mailing Address - Phone:302-541-4137
Mailing Address - Fax:302-541-4137
Practice Address - Street 1:1613 BAY ST
Practice Address - Street 2:
Practice Address - City:FENWICK ISLAND
Practice Address - State:DE
Practice Address - Zip Code:19944-4506
Practice Address - Country:US
Practice Address - Phone:302-541-4137
Practice Address - Fax:302-541-4137
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0003963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine