Provider Demographics
NPI:1972686707
Name:RONA, VIRGIL T (MD)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:T
Last Name:RONA
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 1:500 VINE STREET
Mailing Address - Street 2:BLUE HILLS HOSPTIAL
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-293-6400
Mailing Address - Fax:860-293-6457
Practice Address - Street 1:500 VINE STREET
Practice Address - Street 2:BLUE HILLS HOSPTIAL
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-293-6400
Practice Address - Fax:860-293-6457
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027646207ZP0102X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT790000001Medicare ID - Type UnspecifiedFIRST COAST
G05517Medicare UPIN