MEDICARE: RONDA HERRY CDIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1487352480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDA HERRY CDIP

Provider Business Mailing Address
First Line	:	3607 FOREST HILL RD
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-6344
Country	:	US
Telephone Number	:	443-440-7479
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 FOREST HILL RD
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-6344
Country	:	US
Telephone Number	:	443-440-4479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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Directions to “ RONDA HERRY CDIP” Practice Location

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