Provider Demographics
NPI:1861604589
Name:RONSON, STEPHEN KRYSTJAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KRYSTJAN
Last Name:RONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3930
Mailing Address - Country:US
Mailing Address - Phone:410-682-6800
Mailing Address - Fax:410-682-2783
Practice Address - Street 1:9105 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3930
Practice Address - Country:US
Practice Address - Phone:410-682-6800
Practice Address - Fax:410-682-2783
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1861604589OtherNPI
MD416972700Medicaid
MD416972700Medicaid