1093716821 NPI number — RONDA A ROCKETT MD

Table of content: RONDA A ROCKETT MD (NPI 1093716821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093716821 NPI number — RONDA A ROCKETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCKETT
Provider First Name:
RONDA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093716821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 WORCESTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481-5521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-235-7900
Provider Business Mailing Address Fax Number:
781-237-9930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
173 WORCESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481-5521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-235-7900
Provider Business Practice Location Address Fax Number:
781-237-9930
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  208830 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0140261 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0140261 . This is a "MEDICAID MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3643203 . This is a "AETNA/US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: A34733 . This is a "MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: J23806 . This is a "BCBS MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1053409 . This is a "FALION COMMUNITY HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208830 . This is a "MEDICAL LICENSE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6672596 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208830 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7811253 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H71509 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 583281 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA17063 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".




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