Provider Demographics
NPI:1417995077
Name:RONNER, WANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:RONNER
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 1:801 SPRUCE ST
Mailing Address - Street 2:7H FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5701
Mailing Address - Country:US
Mailing Address - Phone:215-829-2345
Mailing Address - Fax:215-829-3365
Practice Address - Street 1:807 N HADDON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1749
Practice Address - Country:US
Practice Address - Phone:856-429-0400
Practice Address - Fax:856-429-8411
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05255300207VG0400X
PAMD042172E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0436976370OtherHORIZON
NJ043697637006OtherCIGNA
PA000802236OtherHIGHMARK BLUE SHIELD
NJ0828233000OtherAMERIHEALTH HMO
NJ2832953OtherAETNA
NJ0828233000OtherAMERIHEALTH HMO
E64215Medicare UPIN