Provider Demographics
NPI:1790754554
Name:FORD, RONI W (MD)
Entity Type:Individual
Prefix:
First Name:RONI
Middle Name:W
Last Name:FORD
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 1:6 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3546
Mailing Address - Country:US
Mailing Address - Phone:301-977-2070
Mailing Address - Fax:301-330-9452
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3546
Practice Address - Country:US
Practice Address - Phone:301-977-2070
Practice Address - Fax:301-330-9452
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44738207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC52970018OtherCAREFIRST
1713476OtherCIGNA
MD004241100Medicaid
522106345OtherEI
MD52859104OtherCAREFIRST
MD52859104OtherCAREFIRST
003156A94Medicare ID - Type Unspecified
MD004241100Medicaid