1952047730 NPI number — MRS. MELINDA GAIL KONDRACKI LMT

Table of content: MRS. MELINDA GAIL KONDRACKI LMT (NPI 1952047730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952047730 NPI number — MRS. MELINDA GAIL KONDRACKI LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONDRACKI
Provider First Name:
MELINDA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
USSHER
Provider Other First Name:
MELINDA
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952047730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 HARPER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43044-9655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-869-3071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 HARPER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43044-9655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-869-3071
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2022

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: 374U00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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