MEDICARE: DAVID L CONDON MD

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	208M00000X	Hospitalist Physician	35.060321	OH
2	207R00000X	Internal Medicine Physician	35.060321	OH

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	:	1891752994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L CONDON MD

Provider Business Mailing Address
First Line	:	3555 OLENTANGY RIVER RD STE 1080
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3984
Country	:	US
Telephone Number	:	614-268-8164
Fax Number	:	614-268-8406

Provider Business Practice Location Address
First Line	:	3555 OLENTANGY RIVER RD STE 1080
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3984
Country	:	US
Telephone Number	:	614-268-8164
Fax Number	:	614-268-8406

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/16/2011

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Directions to “ DAVID L CONDON MD” Practice Location

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