Healthcare Provider Details

I. General information

NPI: 1073592663
Provider Name (Legal Business Name): JAMES HARRY KONDOLIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

IV. Provider business mailing address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-2378
  • Fax: 330-841-4667
Mailing address:
  • Phone: 330-841-2378
  • Fax: 330-841-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.073301
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.073301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: