Provider Demographics
NPI:1376578237
Name:CICCONE, RONALD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:CICCONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HADDON AVE
Mailing Address - Street 2:SUITE 136
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2101
Mailing Address - Country:US
Mailing Address - Phone:856-869-3126
Mailing Address - Fax:856-833-2050
Practice Address - Street 1:900 HADDON AVE
Practice Address - Street 2:SUITE 136
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2101
Practice Address - Country:US
Practice Address - Phone:856-869-3126
Practice Address - Fax:856-833-2050
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04483700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073809R73Medicare ID - Type UnspecifiedINDIVIDUAL #
NJ074638Medicare ID - Type UnspecifiedGROUP #
NJB39967Medicare UPIN