Healthcare Provider Details

I. General information

NPI: 1417571456
Provider Name (Legal Business Name): KRISTA ROSE RONCONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MEDICAL CENTER DR
FISHERSVILLE VA
22939-2332
US

IV. Provider business mailing address

1652 MURRAY RD
VICTOR NY
14564-9144
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-4000
  • Fax:
Mailing address:
  • Phone: 585-314-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101282754
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number330799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: