Healthcare Provider Details

I. General information

NPI: 1821192337
Provider Name (Legal Business Name): PETER B RONCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE DEPT OF PEDIATRICS
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8067
  • Fax: 317-962-3796
Mailing address:
  • Phone: 317-274-1201
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01060851
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: