Provider Demographics
NPI:1346251659
Name:RONAN, CYNTHIA MARY IV (MD)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MARY
Last Name:RONAN
Suffix:IV
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 SEYMOUR AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1343
Mailing Address - Country:US
Mailing Address - Phone:203-736-6383
Mailing Address - Fax:203-736-0499
Practice Address - Street 1:300 SEYMOUR AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1343
Practice Address - Country:US
Practice Address - Phone:203-736-6383
Practice Address - Fax:203-736-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033188174400000X
CT33188207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001331884Medicaid
CT001331884Medicaid
CTF60221Medicare UPIN