Basic Information
| Provider Information | |||||||||
| NPI: | 1659384014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINCOW | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1705 SOMERSET ST | ||||||||
| Address2: | |||||||||
| City: | DRESHER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190251312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153381811 | ||||||||
| FaxNumber: | 2153383606 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 RIDGEWOOD RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196101196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103756226 | ||||||||
| FaxNumber: | 4845092933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | OS013632 | PA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 2081P2900X | OS013632 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.