Provider Demographics
NPI:1093716821
Name:ROCKETT, RONDA A (MD)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:A
Last Name:ROCKETT
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 1:173 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5521
Mailing Address - Country:US
Mailing Address - Phone:781-235-7900
Mailing Address - Fax:781-237-9930
Practice Address - Street 1:173 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5521
Practice Address - Country:US
Practice Address - Phone:781-235-7900
Practice Address - Fax:781-237-9930
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0140261Medicaid
0140261OtherMEDICAID MA
3643203OtherAETNA/US HEALTHCARE HMO
A34733OtherMEDICARE PIN
J23806OtherBCBS MA
1053409OtherFALION COMMUNITY HP
208830OtherMEDICAL LICENSE #
6672596OtherCIGNA
208830OtherTUFTS
7811253OtherAETNA/US HEALTHCARE
H71509OtherUPIN
583281OtherHEALTHSOURCE
AA17063OtherHPHC
J23806OtherBCBS MA
H71509OtherUPIN