MEDICARE: DR. STEPHEN T KONDASH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35.061621	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180024728	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962404186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN T KONDASH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 631662
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-1662
Country	:	US
Telephone Number	:	859-581-7120
Fax Number	:	859-581-7207

Provider Business Practice Location Address
First Line	:	2841 BOUDINOT AVE
Second Line	:	STE 300
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2496
Country	:	US
Telephone Number	:	513-389-9911
Fax Number	:	513-389-7854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/28/2014

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