Healthcare Provider Details

I. General information

NPI: 1790754554
Provider Name (Legal Business Name): RONI W FORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MONTGOMERY VILLAGE AVE SUITE 322
GAITHERSBURG MD
20879-3546
US

IV. Provider business mailing address

6 MONTGOMERY VILLAGE AVE SUITE 322
GAITHERSBURG MD
20879-3546
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-2070
  • Fax: 301-330-9452
Mailing address:
  • Phone: 301-977-2070
  • Fax: 301-330-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD44738
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: