Provider Demographics
NPI:1083621460
Name:FERNANDEZ-LEDON, RAMON A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:A
Last Name:FERNANDEZ-LEDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1308 MORRIS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3331
Mailing Address - Country:US
Mailing Address - Phone:908-851-2770
Mailing Address - Fax:908-851-9023
Practice Address - Street 1:1308 MORRIS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3331
Practice Address - Country:US
Practice Address - Phone:908-851-2770
Practice Address - Fax:908-851-9023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0670405Medicaid
NJC60234Medicare UPIN
NJ515190Medicare PIN