Provider Demographics
NPI:1508895483
Name:ANTELO, RONNY E (MD)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:E
Last Name:ANTELO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:333 NORTH OXFORD VALLEY ROAD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030
Mailing Address - Country:US
Mailing Address - Phone:215-949-7925
Mailing Address - Fax:215-943-1304
Practice Address - Street 1:333 NORTH OXFORD VALLEY ROAD
Practice Address - Street 2:SUITE 503
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-949-7925
Practice Address - Fax:215-943-1304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2016-03-01
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Provider Licenses
StateLicense IDTaxonomies
PAMD066714L207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1113859OtherKEYSTONE MERCY
PA111885OtherHIGHMARK BLUE SHIELD
PA2257495OtherAETNA
PA0017943500002Medicaid
PA2Y2767OtherELDER HEALTH
PA0293984000OtherINDEPENDENCE BLUE CROSS
PA130021904OtherRAILROAD MEDICARE
PA29404OtherHEALTH PARTNERS
PA1113859OtherKEYSTONE MERCY
PA2257495OtherAETNA