Provider Demographics
NPI:1720076466
Name:RONAN, NAZANIN JELVEH (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZANIN
Middle Name:JELVEH
Last Name:RONAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6507
Mailing Address - Country:US
Mailing Address - Phone:508-539-6000
Mailing Address - Fax:508-477-7028
Practice Address - Street 1:2 JAN SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2377
Practice Address - Country:US
Practice Address - Phone:508-833-8247
Practice Address - Fax:508-833-6535
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9707280Medicaid
MA9707280Medicaid