Provider Demographics
NPI:1073622239
Name:RONEY, NATALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:RONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 REYNOLDS RD
Mailing Address - Street 2:STE A
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1308
Mailing Address - Country:US
Mailing Address - Phone:607-444-5446
Mailing Address - Fax:607-444-5447
Practice Address - Street 1:302 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1308
Practice Address - Country:US
Practice Address - Phone:607-444-5446
Practice Address - Fax:607-444-5447
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440329207N00000X
NY247625207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025090880001Medicaid
NY03246146Medicaid
PA189831Medicare PIN