Provider Demographics
NPI:1043650278
Name:WHITLEY, RONDA M (MD)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:M
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AMES PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-2953
Mailing Address - Country:US
Mailing Address - Phone:973-476-3573
Mailing Address - Fax:
Practice Address - Street 1:1 PATH PLZ
Practice Address - Street 2:CONCOURSE LEVEL
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2905
Practice Address - Country:US
Practice Address - Phone:201-216-6696
Practice Address - Fax:201-216-6694
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07037700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine