Healthcare Provider Details

I. General information

NPI: 1346251659
Provider Name (Legal Business Name): CYNTHIA MARY RONAN IV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SEYMOUR AVE SUITE 108
DERBY CT
06418-1343
US

IV. Provider business mailing address

300 SEYMOUR AVE STE 108
DERBY CT
06418-1343
US

V. Phone/Fax

Practice location:
  • Phone: 203-736-6383
  • Fax: 203-736-0499
Mailing address:
  • Phone: 203-736-6383
  • Fax: 203-736-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number033188
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number33188
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: