Provider Demographics
NPI:1457333684
Name:RONCONE, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:RONCONE
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 1:929 JASONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2464
Mailing Address - Country:US
Mailing Address - Phone:614-538-2256
Mailing Address - Fax:614-538-2256
Practice Address - Street 1:929 JASONWAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2464
Practice Address - Country:US
Practice Address - Phone:614-538-2256
Practice Address - Fax:614-538-2256
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008214207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2478322Medicaid
OH34008214OtherOHIO STATE LICENSE NO
4207371Medicare PIN
OH34008214OtherOHIO STATE LICENSE NO