Provider Demographics
NPI:1184987463
Name:ILIE, RAMONA NICOLETA (MD)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:NICOLETA
Last Name:ILIE
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 1:4801 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3859
Mailing Address - Country:US
Mailing Address - Phone:727-526-3468
Mailing Address - Fax:727-522-3369
Practice Address - Street 1:4801 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-3859
Practice Address - Country:US
Practice Address - Phone:727-526-3468
Practice Address - Fax:727-522-3369
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA79668208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program