Healthcare Provider Details

I. General information

NPI: 1639538879
Provider Name (Legal Business Name): ROBERT KONDOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD SUITE 202
NEWARK DE
19713-4236
US

IV. Provider business mailing address

5 BLACKBIRD CT
NEWARK DE
19702-8633
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-7671
  • Fax:
Mailing address:
  • Phone: 302-383-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: