Basic Information
| Provider Information | |||||||||
| NPI: | 1891752994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONDON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD STE 1080 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688164 | ||||||||
| FaxNumber: | 6142688406 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD STE 1080 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688164 | ||||||||
| FaxNumber: | 6142688406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35.060321 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 35.060321 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0829698 | 05 | OH | MEDICAID |