Healthcare Provider Details

I. General information

NPI: 1982609020
Provider Name (Legal Business Name): DARLA K ONDREKO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DARLA K RADDISH D.O.

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SEVENTH STREET SUITE 100
MARIETTA OH
45750
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-2999
  • Fax: 740-374-3121
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34007254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: