MEDICARE: DR. DORIAN KONDAS PHD

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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1295255313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORIAN KONDAS PHD

Provider Business Mailing Address
First Line	:	6426 ROYAL OAKLAND DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-4800
Country	:	US
Telephone Number	:	812-369-8079
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 E BROAD ST STE 301
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4037
Country	:	US
Telephone Number	:	614-444-8277
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	06/20/2017

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