Provider Demographics
NPI:1477582823
Name:WILLOUGHBY, RONALD P (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:WILLOUGHBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:130 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-6057
Practice Address - Country:US
Practice Address - Phone:609-893-3133
Practice Address - Fax:609-893-7972
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB04822200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2357305Medicaid
NJ652079R63Medicare PIN
NJ652079YBAWMedicare PIN
NJ2357305Medicaid