Basic Information
| Provider Information | |||||||||
| NPI: | 1366479479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RINGOLD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 HIGHLAND AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180179424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108681100 | ||||||||
| FaxNumber: | 6108681111 | ||||||||
| Practice Location | |||||||||
| Address1: | 3735 NAZARETH RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180458338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845038281 | ||||||||
| FaxNumber: | 4845038200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | MD063814L | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01753769 | 05 | PA | MEDICAID |