MEDICARE: DR. JAMES DANA KONDRUP 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	207VG0400X	Gynecology Physician	174463	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1376648337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DANA KONDRUP M.D

Provider Business Mailing Address
First Line	:	PO BOX 11393
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4004
Country	:	US
Telephone Number	:	941-207-5330
Fax Number	:	941-207-5346

Provider Business Practice Location Address
First Line	:	8431 POINTE LOOP DR FL 2
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2232
Country	:	US
Telephone Number	:	941-207-5330
Fax Number	:	941-207-5346

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/14/2020

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