Healthcare Provider Details

I. General information

NPI: 1629562814
Provider Name (Legal Business Name): CLARISSA GRACE RONZIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

143 PALMER ST
QUINCY MA
02169-3329
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-4211
  • Fax:
Mailing address:
  • Phone: 978-886-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6588
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066684
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: