1265684070 NPI number — DR. LINDA CONDRON PHD

Table of content: DR. LINDA CONDRON PHD (NPI 1265684070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265684070 NPI number — DR. LINDA CONDRON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDRON
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265684070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
676 BROOK HOLW
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-6276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-340-5592
Provider Business Mailing Address Fax Number:
614-448-3344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
676 BROOK HOLW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GAHANNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230-6276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-340-5592
Provider Business Practice Location Address Fax Number:
614-448-3344
Provider Enumeration Date:
10/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)