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NPI Code Detail

MEDICARE: TERRENCE MERLE FONDESSY M.D.

MEDICARE: TERRENCE MERLE FONDESSY 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
1207Q00000XFamily Medicine Physician35-050793OH

Other Identifiers

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

General Provider Information

NPI Number : 1528113412
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRENCE MERLE FONDESSY M.D.
Provider Business Mailing Address
First Line : 745 HASKINS RD
Second Line : SUITE B
City : BOWLING GREEN
State : OH
Zip : 43402-1637
Country : US
Telephone Number : 419-353-7069
Fax Number : 419-353-7076
Provider Business Practice Location Address
First Line : 838 E WOOSTER ST
Second Line :
City : BOWLING GREEN
State : OH
Zip : 43402-3186
Country : US
Telephone Number : 419-372-2271
Fax Number : 419-354-3222
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 06/15/2022

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Directions to “ TERRENCE MERLE FONDESSY M.D.” Practice Location

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