Provider Demographics
NPI:1669982872
Name:RONCONE, MARK ANTHONY (FNP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:RONCONE
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:1101 OPAL CT STE 217
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5941
Mailing Address - Country:US
Mailing Address - Phone:240-203-8864
Mailing Address - Fax:240-866-8173
Practice Address - Street 1:1101 OPAL CT STE 217
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5941
Practice Address - Country:US
Practice Address - Phone:402-038-8642
Practice Address - Fax:240-866-8173
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR209146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD287005300Medicaid