Healthcare Provider Details

I. General information

NPI: 1033414719
Provider Name (Legal Business Name): ASHLEY MARY RONCONE PA-C, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MARY WHITTAKER PA-C, MS

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EVES DR # A SUITE 100
MARLTON NJ
08053-3195
US

IV. Provider business mailing address

4 EVES DR # A SUITE 100
MARLTON NJ
08053-3195
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-9400
  • Fax: 609-267-9457
Mailing address:
  • Phone: 609-267-9400
  • Fax: 609-267-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00255000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00255000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: